Provider First Line Business Practice Location Address:
1022 S PIONEER WAY STE A
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:
98837-2271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-762-2466
Provider Business Practice Location Address Fax Number:
509-762-2465
Provider Enumeration Date:
11/04/2013