Provider First Line Business Practice Location Address:
1606 S 73RD 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:
98908-1969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-790-8774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2025