Provider First Line Business Practice Location Address:
2006 W LINCOLN AVE # A
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:
98902-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-573-4816
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2025