Provider First Line Business Practice Location Address:
423 W 3RD AVE STE A
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:
98837-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-764-8642
Provider Business Practice Location Address Fax Number:
509-764-8644
Provider Enumeration Date:
02/26/2010