Provider First Line Business Practice Location Address:
1115 W LINCOLN AVE STE 119
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:
98902-2571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-902-8428
Provider Business Practice Location Address Fax Number:
509-902-8429
Provider Enumeration Date:
05/31/2023