Provider First Line Business Practice Location Address:
8910 MAIN ST E
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-8988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-299-6556
Provider Business Practice Location Address Fax Number:
253-299-6048
Provider Enumeration Date:
10/27/2006