Provider First Line Business Practice Location Address:
508 S 4TH 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:
98902-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-574-6139
Provider Business Practice Location Address Fax Number:
509-574-6139
Provider Enumeration Date:
01/26/2015