Provider First Line Business Practice Location Address:
1400 E. KINCAID STREET
Provider Second Line Business Practice Location Address:
STE A
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:
360-428-2501
Provider Business Practice Location Address Fax Number:
360-428-2596
Provider Enumeration Date:
06/09/2006