Provider First Line Business Practice Location Address:
402 E YAKIMA AVE STE 447C
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:
98901-5407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-875-6593
Provider Business Practice Location Address Fax Number:
262-754-0897
Provider Enumeration Date:
04/11/2022