Provider First Line Business Practice Location Address:
601 S PIONEER WAY
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:
98837-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-764-4721
Provider Business Practice Location Address Fax Number:
509-764-7412
Provider Enumeration Date:
10/25/2010