Provider First Line Business Practice Location Address:
1819 W J ST
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:
98902-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-0386
Provider Business Practice Location Address Fax Number:
509-453-1279
Provider Enumeration Date:
11/09/2016