Provider First Line Business Practice Location Address:
2203 OLD HIGHWAY 99 S RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT 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:
360-542-8810
Provider Business Practice Location Address Fax Number:
360-542-8811
Provider Enumeration Date:
12/04/2008