Provider First Line Business Practice Location Address:
3011 COLUMBIA STREET
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:
98660-2237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-693-1291
Provider Business Practice Location Address Fax Number:
360-693-3392
Provider Enumeration Date:
12/15/2006