Provider First Line Business Practice Location Address:
901 S 72ND AVE APT 116
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:
98908-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-834-8562
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2026