Provider First Line Business Practice Location Address:
1402 E CRAIG STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-4001
Provider Business Practice Location Address Fax Number:
509-766-1840
Provider Enumeration Date:
09/10/2009