Provider First Line Business Practice Location Address:
500 UNIVERSITY PKWY APT 315
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:
98901-8233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-619-1290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2020