Provider First Line Business Practice Location Address:
5020 NE 48TH ST
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:
98661-2976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-926-3424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2010