Provider First Line Business Practice Location Address:
9106 NE HIGHWAY 99 STE H
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98665-8949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-601-0111
Provider Business Practice Location Address Fax Number:
360-546-2473
Provider Enumeration Date:
03/29/2007