Provider First Line Business Practice Location Address:
1525 E WHEELER 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:
98837-9753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-5402
Provider Business Practice Location Address Fax Number:
509-766-2589
Provider Enumeration Date:
10/10/2006