Provider First Line Business Practice Location Address:
14619 NE 49TH ST STE B
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:
98682-6486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-604-6700
Provider Business Practice Location Address Fax Number:
360-604-6702
Provider Enumeration Date:
10/18/2006