Provider First Line Business Practice Location Address:
2323 W BROADWAY AVE STE 4
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-663-1578
Provider Business Practice Location Address Fax Number:
509-663-0174
Provider Enumeration Date:
03/15/2010