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208 S Division St Moses Lake WA 98837-1954 | |
| (509) 350-5260 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 208 S Division St, Moses Lake, Washington |
| Authorized Official Name and Position | Ryan Lee Lavine (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5094434680 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9 S Washington St Suite 505 Spokane WA 99201-3719 Ph: (509) 443-4680 | 208 S Division St Moses Lake WA 98837-1954 Ph: (509) 350-5260 |
| NPI Number | 1386976280 |
|---|---|
| Provider Enumeration Date | 02/03/2010 |
| Last Update Date | 02/03/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386976280 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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