Provider First Line Business Practice Location Address:
21509 HWY 410 E
Provider Second Line Business Practice Location Address:
SUITE 1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-891-2160
Provider Business Practice Location Address Fax Number:
253-891-2171
Provider Enumeration Date:
04/20/2006