Provider First Line Business Practice Location Address:
3808 TIETON DR STE 1
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:
98902-3691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-3421
Provider Business Practice Location Address Fax Number:
509-972-0980
Provider Enumeration Date:
09/23/2015