Provider First Line Business Practice Location Address:
4214 NE MINNEHAHA ST STE 200
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:
98661-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-993-8660
Provider Business Practice Location Address Fax Number:
360-993-8687
Provider Enumeration Date:
12/05/2012