Organization
BONNEY LAKE CLINICAL MASSAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN SISCO (MEMBER LLC)
(253) 862-4441
Entity
Organization
Contact information
Practice address
21157 STATE ROUTE 410 E, BONNEY LAKE, WA 98391-8457
(253) 862-4441
Mailing address
PO BOX 757, ENUMCLAW, WA 98022-0757
(253) 862-4441
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
01/15/2010
Last updated
01/15/2010
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