Provider First Line Business Practice Location Address:
8008 NE 71ST LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98662-3673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-944-9530
Provider Business Practice Location Address Fax Number:
360-260-1949
Provider Enumeration Date:
01/08/2007