Provider First Line Business Practice Location Address:
505 NE 87TH AVE
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-1989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-892-1635
Provider Business Practice Location Address Fax Number:
360-892-3146
Provider Enumeration Date:
04/09/2007