Provider First Line Business Practice Location Address:
1107 S JUNIPER DR
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:
98837-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-764-1583
Provider Business Practice Location Address Fax Number:
509-764-5511
Provider Enumeration Date:
05/09/2007