Provider First Line Business Practice Location Address:
18503 NE 219TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE GROUND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98604-9282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-687-5666
Provider Business Practice Location Address Fax Number:
360-666-8346
Provider Enumeration Date:
09/26/2005