Provider First Line Business Practice Location Address:
801 SE PARK CREST AVENUE
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:
98684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-260-2200
Provider Business Practice Location Address Fax Number:
310-323-1570
Provider Enumeration Date:
07/28/2010