Provider First Line Business Practice Location Address:
13720 NE 28TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98682-8048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-253-0300
Provider Business Practice Location Address Fax Number:
360-253-8330
Provider Enumeration Date:
11/16/2006