Provider First Line Business Practice Location Address:
313 FIG 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:
98837-1789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-398-0401
Provider Business Practice Location Address Fax Number:
509-356-5709
Provider Enumeration Date:
04/30/2008