Provider First Line Business Practice Location Address:
30 W WASHINGTON AVE APT 3
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:
98903-1554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-864-0042
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2024