Provider First Line Business Practice Location Address:
11801 NE 65TH ST
Provider Second Line Business Practice Location Address:
#A
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98662-5552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-892-0208
Provider Business Practice Location Address Fax Number:
360-892-9081
Provider Enumeration Date:
02/27/2008