Provider First Line Business Practice Location Address:
105 N 4TH 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:
98902-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-314-0343
Provider Business Practice Location Address Fax Number:
509-573-7192
Provider Enumeration Date:
11/03/2021