Provider First Line Business Practice Location Address:
803 SHARON AVE E
Provider Second Line Business Practice Location Address:
MOSES LAKE HIGH SCHOOL
Provider Business Practice Location Address City Name:
MOSES LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98837-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-766-2666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2006