Provider First Line Business Practice Location Address:
411 S 12TH AVE STE 2
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:
98902-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-225-9960
Provider Business Practice Location Address Fax Number:
509-420-9767
Provider Enumeration Date:
05/05/2026