Provider First Line Business Practice Location Address:
300 EAST 24TH STREET
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:
98663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-335-1195
Provider Business Practice Location Address Fax Number:
360-882-7673
Provider Enumeration Date:
04/21/2010