Provider First Line Business Practice Location Address:
701 E 3RD AVE
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:
98837-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-2204
Provider Business Practice Location Address Fax Number:
509-765-2291
Provider Enumeration Date:
06/16/2005