Provider First Line Business Practice Location Address:
9411 NE HWY 99
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-571-8515
Provider Business Practice Location Address Fax Number:
360-571-8516
Provider Enumeration Date:
01/19/2006