Provider First Line Business Practice Location Address:
100 E 13TH ST
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98660-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-256-3686
Provider Business Practice Location Address Fax Number:
360-694-4681
Provider Enumeration Date:
09/22/2006