Provider First Line Business Practice Location Address:
2403 POWERHOUSE RD
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:
98902-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-881-0702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2026