Provider First Line Business Practice Location Address:
6916 NE FOURTH PLAIN BLVD
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:
98661-7254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-694-7070
Provider Business Practice Location Address Fax Number:
360-737-7880
Provider Enumeration Date:
04/11/2007