Provider First Line Business Practice Location Address:
6700 NE 162ND AVE
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98682-3858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-567-0633
Provider Business Practice Location Address Fax Number:
360-567-0635
Provider Enumeration Date:
07/31/2006