Provider First Line Business Practice Location Address:
1015 S 16TH AVE BLDG 3
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:
98902-5316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-574-4919
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2025