Provider First Line Business Practice Location Address:
1550 S PIONEER WAY STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOSES LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98837-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-793-9784
Provider Business Practice Location Address Fax Number:
509-764-3280
Provider Enumeration Date:
01/15/2007