Provider First Line Business Practice Location Address:
3303 NE 44TH STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-823-0888
Provider Business Practice Location Address Fax Number:
360-823-0889
Provider Enumeration Date:
05/25/2006