Provider First Line Business Practice Location Address:
524 S DIVISION ST
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:
98837-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-8010
Provider Business Practice Location Address Fax Number:
509-765-7007
Provider Enumeration Date:
10/04/2006