Provider First Line Business Practice Location Address:
530 W VALLEY RD STE D
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:
98837-1575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-8978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007