Provider First Line Business Practice Location Address:
9901 NE 7TH AVE
Provider Second Line Business Practice Location Address:
STE A 201
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98685-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-573-4660
Provider Business Practice Location Address Fax Number:
360-694-4024
Provider Enumeration Date:
02/16/2007