Provider First Line Business Practice Location Address:
961 E NELSON RD
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:
98837-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-766-2833
Provider Business Practice Location Address Fax Number:
509-766-2028
Provider Enumeration Date:
08/12/2024