Provider First Line Business Practice Location Address:
500 UNIVERSITY PKWY APT 143
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:
98901-8225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-486-4126
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2020