Provider First Line Business Practice Location Address:
5113 NW 145TH 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:
98685-0514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-500-2211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2010