Provider First Line Business Practice Location Address:
20904 HWY 410
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:
98390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-891-7333
Provider Business Practice Location Address Fax Number:
253-891-7327
Provider Enumeration Date:
06/24/2006