Provider First Line Business Practice Location Address:
210 S 86TH PL
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:
98908-1441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-961-4754
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2023