Provider First Line Business Practice Location Address:
2211 NE 139TH 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:
98686-2742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-464-9034
Provider Business Practice Location Address Fax Number:
503-216-9363
Provider Enumeration Date:
07/03/2006