Provider First Line Business Practice Location Address:
6680 NE 159TH AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98682-3880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-449-3937
Provider Business Practice Location Address Fax Number:
360-449-3094
Provider Enumeration Date:
03/27/2007