Provider First Line Business Practice Location Address:
725 N STANLEY ST STE D
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:
99022-8939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-2531
Provider Business Practice Location Address Fax Number:
509-755-6580
Provider Enumeration Date:
08/01/2016