Provider First Line Business Practice Location Address:
3003 TIETON DR STE 230
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:
98902-3684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-746-4189
Provider Business Practice Location Address Fax Number:
509-249-4460
Provider Enumeration Date:
06/23/2026