Provider First Line Business Practice Location Address:
312 S. BALSAM ST.
Provider Second Line Business Practice Location Address:
STE A
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:
509-766-1283
Provider Business Practice Location Address Fax Number:
509-766-0306
Provider Enumeration Date:
08/29/2006