Provider First Line Business Practice Location Address:
616 S 30TH 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:
98902-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-895-7149
Provider Business Practice Location Address Fax Number:
509-895-7148
Provider Enumeration Date:
03/19/2019