Provider First Line Business Practice Location Address:
1605 SUMMITVIEW AVE
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:
98902-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-424-3796
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2016