Provider First Line Business Practice Location Address:
3101 SE 192ND AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98683-1442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-553-7480
Provider Business Practice Location Address Fax Number:
360-553-7485
Provider Enumeration Date:
05/18/2007