Provider First Line Business Practice Location Address:
2525 NE 139TH ST
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98686-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-397-2880
Provider Business Practice Location Address Fax Number:
360-604-1794
Provider Enumeration Date:
06/20/2006