Provider First Line Business Practice Location Address:
1630 S 16TH AVE
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-853-2395
Provider Business Practice Location Address Fax Number:
509-454-4115
Provider Enumeration Date:
08/19/2021