Provider First Line Business Practice Location Address:
2121 NE 139TH STREET
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE BUILDING B, SUITE 150
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:
360-487-1855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2025