Provider First Line Business Practice Location Address:
8509 NE 69TH 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:
98662-4370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-883-3569
Provider Business Practice Location Address Fax Number:
360-883-3568
Provider Enumeration Date:
04/02/2007