Provider First Line Business Practice Location Address:
850 WEST 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-299-4466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2006