Provider First Line Business Practice Location Address:
14129 S SHOREVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDICAL LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99022-9345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-299-9184
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2013