Provider First Line Business Practice Location Address:
12202 209TH AVE CT. E.
Provider Second Line Business Practice Location Address:
LIBERTY RIDGE ELEMENTARY SCHOOL
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:
253-891-4800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2017