Provider First Line Business Practice Location Address:
1400 E KINCAID ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98274-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-428-2500
Provider Business Practice Location Address Fax Number:
360-424-2522
Provider Enumeration Date:
03/24/2010