Provider First Line Business Practice Location Address:
19205 STATE ROUTE 410 E
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:
98391-6305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-826-9156
Provider Business Practice Location Address Fax Number:
253-826-9158
Provider Enumeration Date:
09/05/2020