Provider First Line Business Practice Location Address:
13516 NE 72ND ST
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:
98682-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-910-4267
Provider Business Practice Location Address Fax Number:
360-718-2566
Provider Enumeration Date:
04/20/2009