Provider First Line Business Practice Location Address:
845 E 3RD AVE STE 11
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:
98837-5902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-766-1880
Provider Business Practice Location Address Fax Number:
509-766-1577
Provider Enumeration Date:
07/19/2006