Provider First Line Business Practice Location Address:
1409 FRANKLIN STREET
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-696-8569
Provider Business Practice Location Address Fax Number:
360-254-5178
Provider Enumeration Date:
07/20/2010