Provider First Line Business Practice Location Address:
800 FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98660-3355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-828-1429
Provider Business Practice Location Address Fax Number:
360-719-5746
Provider Enumeration Date:
11/20/2012