Provider First Line Business Practice Location Address:
801 E WHEELER RD
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:
98837-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-5606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006