Provider First Line Business Practice Location Address:
1603 FOURTH PLAIN BLVD
Provider Second Line Business Practice Location Address:
VA MEDICAL CENTER NSCU
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-220-8262
Provider Business Practice Location Address Fax Number:
360-737-1426
Provider Enumeration Date:
09/13/2006