Provider First Line Business Practice Location Address:
900 NE 139TH ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98685-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-433-0022
Provider Business Practice Location Address Fax Number:
360-433-6159
Provider Enumeration Date:
07/10/2006