Provider First Line Business Practice Location Address:
11700 NE 95TH ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98682-2399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-735-0222
Provider Business Practice Location Address Fax Number:
360-735-0223
Provider Enumeration Date:
12/20/2006