Provider First Line Business Practice Location Address:
2109A W LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-0509
Provider Business Practice Location Address Fax Number:
509-654-9670
Provider Enumeration Date:
11/23/2021