Provider First Line Business Practice Location Address:
1103 S 72ND AVE
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:
98908-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-823-1653
Provider Business Practice Location Address Fax Number:
509-823-1654
Provider Enumeration Date:
05/29/2025