Provider First Line Business Practice Location Address:
1550 S PIONEER WAY
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:
98837-4613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-793-9790
Provider Business Practice Location Address Fax Number:
509-764-3255
Provider Enumeration Date:
10/15/2010