Provider First Line Business Practice Location Address:
9013 NE HIGHWAY 99
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98665-8942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-566-1400
Provider Business Practice Location Address Fax Number:
360-566-1402
Provider Enumeration Date:
06/20/2008