Provider First Line Business Practice Location Address:
208 HOSPITAL PARKWAY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-428-8260
Provider Business Practice Location Address Fax Number:
360-428-8576
Provider Enumeration Date:
10/27/2006