Provider First Line Business Practice Location Address:
S 2320 SALNAVE RD
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:
99022-0200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-299-1978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2007