Provider First Line Business Practice Location Address:
2121 NE 139TH ST STE 360
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:
98686-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-7162
Provider Business Practice Location Address Fax Number:
360-487-1975
Provider Enumeration Date:
05/22/2007