Provider First Line Business Practice Location Address:
9203 S FREEMAN 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:
99022-8504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-327-7589
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2021