Provider First Line Business Practice Location Address:
5500 NE 82ND 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:
98662-9410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-892-1100
Provider Business Practice Location Address Fax Number:
360-896-3594
Provider Enumeration Date:
09/02/2011