Provider First Line Business Practice Location Address:
1900 NE 162ND AVE BLDG C
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:
98684-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-891-1809
Provider Business Practice Location Address Fax Number:
360-604-1991
Provider Enumeration Date:
02/19/2010