Provider First Line Business Practice Location Address:
2709 W BROADWAY AVENUE
Provider Second Line Business Practice Location Address:
SOUTHGATE PHARMACY
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:
509-765-9332
Provider Business Practice Location Address Fax Number:
509-765-4761
Provider Enumeration Date:
02/19/2018