Provider First Line Business Practice Location Address:
1105 N OLSON HILL CT
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:
99022-8850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-270-1829
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2023