Provider First Line Business Practice Location Address:
1300 NE 134TH STREET
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:
98685-2747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-546-5208
Provider Business Practice Location Address Fax Number:
360-574-2878
Provider Enumeration Date:
11/28/2006