Provider First Line Business Practice Location Address:
14806 NE 70TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98682-3812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-281-2872
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2026