Provider First Line Business Practice Location Address:
18008 STATE ROUTE 410 E STE A
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:
98391-7113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-863-7005
Provider Business Practice Location Address Fax Number:
253-863-6004
Provider Enumeration Date:
08/14/2006