Provider First Line Business Practice Location Address:
836 E PLUM ST
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:
98837-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-9239
Provider Business Practice Location Address Fax Number:
509-765-4124
Provider Enumeration Date:
04/17/2012