Provider First Line Business Practice Location Address:
2526 S 12TH 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:
98903-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-4364
Provider Business Practice Location Address Fax Number:
509-571-1614
Provider Enumeration Date:
07/23/2026