Provider First Line Business Practice Location Address:
600 N 4TH STREET
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:
98273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-848-6755
Provider Business Practice Location Address Fax Number:
360-989-3997
Provider Enumeration Date:
03/28/2007