Provider First Line Business Practice Location Address:
621 S 22ND 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:
98902-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-941-0005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2026