Provider First Line Business Practice Location Address:
317 S ASH ST
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:
98837-1948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-764-5399
Provider Business Practice Location Address Fax Number:
509-765-4757
Provider Enumeration Date:
04/24/2007