Provider First Line Business Practice Location Address:
2200 S MAIERS RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MOSES LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98837-8818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-764-8626
Provider Business Practice Location Address Fax Number:
509-764-8628
Provider Enumeration Date:
09/06/2013