Provider First Line Business Practice Location Address:
501 NW 88TH 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:
98665-7650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-522-6169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2008