Provider First Line Business Practice Location Address:
1405 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:
98837-2458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-766-9744
Provider Business Practice Location Address Fax Number:
509-766-9745
Provider Enumeration Date:
06/01/2013