Provider First Line Business Practice Location Address:
505 S. DIVISION STREET
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:
98837-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-8403
Provider Business Practice Location Address Fax Number:
509-765-3657
Provider Enumeration Date:
02/21/2007