Provider First Line Business Practice Location Address:
208 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:
98837-1954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-350-5260
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2010