Provider First Line Business Practice Location Address:
810 N 6TH AVE APT 106
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:
98902-1470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-902-4709
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2026