Provider First Line Business Practice Location Address:
1330 N 16TH 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:
98902-1354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-341-6282
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2022