Provider First Line Business Practice Location Address:
424 W 3RD AVE
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:
98837-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-9681
Provider Business Practice Location Address Fax Number:
509-765-4123
Provider Enumeration Date:
05/01/2025