Provider First Line Business Practice Location Address:
420 S LEGG 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:
99022-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-739-2262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2025