Provider First Line Business Practice Location Address:
1373 ROAD F.2 NE
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:
98837-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-237-2132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2009