Provider First Line Business Practice Location Address:
6101 CROWN CREST 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:
98903-1288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-930-7481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2026