Provider First Line Business Practice Location Address:
1308 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:
98837-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-5141
Provider Business Practice Location Address Fax Number:
509-765-5891
Provider Enumeration Date:
05/18/2007