Provider First Line Business Practice Location Address:
800 N STRATFORD 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:
98837-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-2255
Provider Business Practice Location Address Fax Number:
509-765-1155
Provider Enumeration Date:
05/19/2016