Provider First Line Business Practice Location Address:
8500 NE HAZEL DELL AVE
Provider Second Line Business Practice Location Address:
APT K12
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98665-8069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-576-1016
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2006