Provider First Line Business Practice Location Address:
1555 S. PILGRIM 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:
98837-4623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-350-8928
Provider Business Practice Location Address Fax Number:
509-473-0745
Provider Enumeration Date:
12/01/2010