Provider First Line Business Practice Location Address:
552 NE 138TH PL
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:
98684-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-367-3134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2006