Provider First Line Business Practice Location Address:
1200 NE 99TH 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:
98665-8909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-573-8181
Provider Business Practice Location Address Fax Number:
360-573-8186
Provider Enumeration Date:
07/28/2006