Provider First Line Business Practice Location Address:
108 N JEFFERSON ST
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:
99022-9613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-496-2857
Provider Business Practice Location Address Fax Number:
509-315-5048
Provider Enumeration Date:
04/07/2008