Provider First Line Business Practice Location Address:
505 N 2ND ST UNIT 1
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:
98901-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-401-0769
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2025