Provider First Line Business Practice Location Address:
620 S 12TH ST
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:
98901-3169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-941-0076
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2020