Provider First Line Business Practice Location Address:
4804 SUMMITVIEW AVE STE 2
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:
98908-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-899-3247
Provider Business Practice Location Address Fax Number:
509-268-2993
Provider Enumeration Date:
05/22/2026