Provider First Line Business Practice Location Address:
800 NE TENNEY RD
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:
98685-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-571-2573
Provider Business Practice Location Address Fax Number:
360-571-2567
Provider Enumeration Date:
03/07/2012