Provider First Line Business Practice Location Address:
6739 24TH AVE NE BLDG 2402
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:
98837-3243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-289-0981
Provider Business Practice Location Address Fax Number:
509-762-6737
Provider Enumeration Date:
03/09/2021