Provider First Line Business Practice Location Address:
1990 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SEDRO WOOLLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-854-2750
Provider Business Practice Location Address Fax Number:
360-854-2755
Provider Enumeration Date:
01/28/2006