Provider First Line Business Practice Location Address:
8614 E MILL PLAIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-2059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-9991
Provider Business Practice Location Address Fax Number:
360-254-9997
Provider Enumeration Date:
12/28/2006