Provider First Line Business Practice Location Address:
615 S DIVISION ST
Provider Second Line Business Practice Location Address:
STE C3
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:
509-764-1937
Provider Business Practice Location Address Fax Number:
509-764-1938
Provider Enumeration Date:
08/25/2006