Provider First Line Business Practice Location Address:
1302 FAIRBANKS 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:
98902-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-759-9092
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2017