Provider First Line Business Practice Location Address:
14208 S SHOREVIEW DR
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:
99022-9346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-263-8792
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2024