Provider First Line Business Practice Location Address:
701 NE 136TH 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:
98684-6937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-751-6556
Provider Business Practice Location Address Fax Number:
360-282-1043
Provider Enumeration Date:
04/02/2026