Provider First Line Business Practice Location Address:
21515 STATE ROUTE 410 E
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-826-9000
Provider Business Practice Location Address Fax Number:
253-826-0328
Provider Enumeration Date:
01/24/2007