Provider First Line Business Practice Location Address:
1200 NE 99TH 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:
98665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-573-8181
Provider Business Practice Location Address Fax Number:
360-573-8186
Provider Enumeration Date:
10/10/2006