Provider First Line Business Practice Location Address:
8700 NE VANCOUVER MALL DR
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98662-6420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-253-3663
Provider Business Practice Location Address Fax Number:
360-253-3666
Provider Enumeration Date:
10/11/2006