Provider First Line Business Practice Location Address:
47 E. WA 902
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-330-3150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2017