Provider First Line Business Practice Location Address:
200 NE MOTHER JOSEPH PLACE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-449-6300
Provider Business Practice Location Address Fax Number:
360-449-6370
Provider Enumeration Date:
10/02/2006