Provider First Line Business Practice Location Address:
9105 NE HIGHWAY 99
Provider Second Line Business Practice Location Address:
STE 202, BUILDING A
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98665-8961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-639-7595
Provider Business Practice Location Address Fax Number:
360-693-7262
Provider Enumeration Date:
07/07/2006