Provider First Line Business Practice Location Address:
5401 W WALNUT ST APT 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:
98908-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-836-1530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2025