Provider First Line Business Practice Location Address:
13115 NE 4TH ST
Provider Second Line Business Practice Location Address:
STE 230
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-448-2047
Provider Business Practice Location Address Fax Number:
360-450-2289
Provider Enumeration Date:
06/03/2006