Provider First Line Business Practice Location Address:
3303 NE MINNEHAHA ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98663-1499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-750-0250
Provider Business Practice Location Address Fax Number:
360-750-0253
Provider Enumeration Date:
12/07/2007