Provider First Line Business Practice Location Address:
307 SOUTH 12TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-469-4996
Provider Business Practice Location Address Fax Number:
509-469-4922
Provider Enumeration Date:
05/13/2016