Individual
JESSICA THOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
19102 STATE ROUTE 410 E STE A, BONNEY LAKE, WA 98391-8449
(253) 863-6378
Mailing address
19102 STATE ROUTE 410 E. #A, BONNEY LAKE, WA 98391
(253) 863-6378
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 00019936
WA
Other
Enumeration date
03/18/2011
Last updated
04/20/2012
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