Provider First Line Business Practice Location Address:
918 SE 164TH AVE.
Provider Second Line Business Practice Location Address:
STE. 3
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:
360-253-9482
Provider Business Practice Location Address Fax Number:
360-253-5366
Provider Enumeration Date:
02/18/2010