Provider First Line Business Practice Location Address:
2101 NE 139TH ST
Provider Second Line Business Practice Location Address:
SUITE 255
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-885-7926
Provider Business Practice Location Address Fax Number:
360-397-4229
Provider Enumeration Date:
04/09/2008