Provider First Line Business Practice Location Address:
846 E NORMAN RD
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:
98901-7972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-852-4020
Provider Business Practice Location Address Fax Number:
509-852-4020
Provider Enumeration Date:
07/20/2026