Provider First Line Business Practice Location Address:
850 MAPLE STREET
Provider Second Line Business Practice Location Address:
ATTN: PHARMACY
Provider Business Practice Location Address City Name:
MEDICAL LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99022-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-565-4348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2014