Provider First Line Business Practice Location Address:
7012 NE 40TH 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:
98661-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-5254
Provider Business Practice Location Address Fax Number:
360-944-3835
Provider Enumeration Date:
10/12/2006