Provider First Line Business Practice Location Address:
234 NE 136TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-450-6800
Provider Business Practice Location Address Fax Number:
360-989-1150
Provider Enumeration Date:
05/21/2007