Provider First Line Business Practice Location Address:
10920 199TH AVE. CT. E.
Provider Second Line Business Practice Location Address:
BONNEY LAKE HS,
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:
253-891-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2015