Provider First Line Business Practice Location Address:
1315 EAST DIVISION ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-424-8951
Provider Business Practice Location Address Fax Number:
360-424-8953
Provider Enumeration Date:
05/04/2007