Provider First Line Business Practice Location Address:
206 S 11TH AVE STE 48
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:
98902-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-419-7934
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2026