Provider First Line Business Practice Location Address:
LAKELAND VILLAGE
Provider Second Line Business Practice Location Address:
2320 SALNAVE RD.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-299-1800
Provider Business Practice Location Address Fax Number:
509-299-1801
Provider Enumeration Date:
04/08/2009