Provider First Line Business Practice Location Address:
9925 214TH AVE 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:
98391-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-863-4594
Provider Business Practice Location Address Fax Number:
253-863-5061
Provider Enumeration Date:
07/15/2009