Provider First Line Business Practice Location Address:
200 NE MOTHER JOSEPH PL
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-892-5701
Provider Business Practice Location Address Fax Number:
360-253-4208
Provider Enumeration Date:
08/22/2005