Provider First Line Business Practice Location Address:
6006 SUMMITVIEW AVE #HL
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:
98908-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-910-5519
Provider Business Practice Location Address Fax Number:
888-538-7694
Provider Enumeration Date:
05/21/2026