Provider First Line Business Practice Location Address:
13118 NE 4TH ST
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:
98684-5809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-2323
Provider Business Practice Location Address Fax Number:
360-254-8289
Provider Enumeration Date:
08/31/2006