Provider First Line Business Practice Location Address:
10501 NE HIGHWAY 99
Provider Second Line Business Practice Location Address:
SUITE 23
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98686-5697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-896-5918
Provider Business Practice Location Address Fax Number:
360-896-5302
Provider Enumeration Date:
01/23/2007