Provider First Line Business Practice Location Address:
14300 NE 20TH AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98686-1446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-571-2380
Provider Business Practice Location Address Fax Number:
360-571-2444
Provider Enumeration Date:
06/14/2006