Provider First Line Business Practice Location Address:
2211 NE 139TH ST
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98686-2742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-3879
Provider Business Practice Location Address Fax Number:
503-413-4379
Provider Enumeration Date:
12/12/2006