Provider First Line Business Practice Location Address:
805 N MOUNT AIX WAY
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:
98901-5365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-307-7315
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2025