Provider First Line Business Practice Location Address:
850 MAPLE STREET
Provider Second Line Business Practice Location Address:
EASTERN STATE HOSPITAL
Provider Business Practice Location Address City Name:
MEDICAL LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99022-0800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-565-4550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2017