Provider First Line Business Practice Location Address:
1415 LAKESIDE CT STE 102
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:
98902-7300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-823-7823
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2026