Provider First Line Business Practice Location Address:
105 S 3RD ST STE 105
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:
98901-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-731-3191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2026