Provider First Line Business Practice Location Address:
1015 S 40TH AVE STE 24
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:
98908-3868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-494-3578
Provider Business Practice Location Address Fax Number:
509-966-5731
Provider Enumeration Date:
11/26/2025