Provider First Line Business Practice Location Address:
21155 STATE ROUTE 410 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-8457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-862-2929
Provider Business Practice Location Address Fax Number:
253-299-6664
Provider Enumeration Date:
02/21/2007