Provider First Line Business Practice Location Address:
307 S. 13TH STREET
Provider Second Line Business Practice Location Address:
SUITE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-336-9757
Provider Business Practice Location Address Fax Number:
360-336-2088
Provider Enumeration Date:
05/18/2007