Provider First Line Business Practice Location Address:
835 E COLONIAL AVE
Provider Second Line Business Practice Location Address:
SUITE 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:
98837-4617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-764-8500
Provider Business Practice Location Address Fax Number:
509-663-2147
Provider Enumeration Date:
02/25/2008