Provider First Line Business Practice Location Address:
605 S 69TH AVE APT B
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:
98908-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-433-4060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2022