Provider First Line Business Practice Location Address:
725 N STANLEY ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
MEDICAL LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99022-8939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-299-5145
Provider Business Practice Location Address Fax Number:
509-299-5154
Provider Enumeration Date:
08/15/2014