Provider First Line Business Practice Location Address:
1612 NE 78TH 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:
98665-9635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-433-2727
Provider Business Practice Location Address Fax Number:
503-200-1420
Provider Enumeration Date:
09/15/2008