Provider First Line Business Practice Location Address:
615 S DIVISION 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:
98837-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-766-9450
Provider Business Practice Location Address Fax Number:
509-766-1954
Provider Enumeration Date:
07/25/2006