Provider First Line Business Practice Location Address:
1320 E DIVISION 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:
98274-4133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-424-6161
Provider Business Practice Location Address Fax Number:
360-848-1167
Provider Enumeration Date:
08/30/2005