Provider First Line Business Practice Location Address:
111 S 12TH ST STE D
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:
98274-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-734-2800
Provider Business Practice Location Address Fax Number:
360-734-3818
Provider Enumeration Date:
06/15/2006