Provider First Line Business Practice Location Address:
802 NE 146TH ST
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:
98685-5741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-690-6622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2006