Provider First Line Business Practice Location Address:
403 N 63RD 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:
98908-2707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-606-0177
Provider Business Practice Location Address Fax Number:
509-344-1054
Provider Enumeration Date:
04/22/2021