Provider First Line Business Practice Location Address:
200 NE MOTHER JOSEPH PL
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-514-2048
Provider Business Practice Location Address Fax Number:
360-514-3155
Provider Enumeration Date:
10/09/2007