Provider First Line Business Practice Location Address:
1010 E LAKE ST
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:
99022-5138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-565-3300
Provider Business Practice Location Address Fax Number:
509-565-3301
Provider Enumeration Date:
08/20/2024