Individual
MS. ALEXANDREA LEE PETTYJOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
6420 195TH AVE E, BONNEY LAKE, WA 98391-8858
(253) 709-7070
Mailing address
6420 195TH AVE E, BONNEY LAKE, WA 98391-8858
(253) 709-7070
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
MA 60040360
WA
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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