Provider First Line Business Practice Location Address:
1336 S PIONEER WAY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
MOSES LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98837-4622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-4431
Provider Business Practice Location Address Fax Number:
509-765-4103
Provider Enumeration Date:
04/19/2006