Provider First Line Business Practice Location Address:
2323 W BROADWAY AVE STE 6
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:
98837-2676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-429-8155
Provider Business Practice Location Address Fax Number:
509-689-0879
Provider Enumeration Date:
03/24/2014