Provider First Line Business Practice Location Address:
2501 NE 138TH AVE
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:
98684-7286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-565-7101
Provider Business Practice Location Address Fax Number:
206-565-7101
Provider Enumeration Date:
08/31/2026