Provider First Line Business Practice Location Address:
20631 HWY 410 E.
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-6390
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:
03/07/2008