Individual
MR. ROBERT WAYNE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDP
Contact information
Practice address
10215 214TH AVE E, BONNEY LAKE, WA 98391-3909
(253) 862-7374
(253) 862-0448
Mailing address
10215 214TH AVE E, BONNEY LAKE, WA 98391-3909
(253) 862-7374
(253) 862-0448
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CP00002606
WA
Other
Enumeration date
02/13/2007
Last updated
02/28/2013
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