Provider First Line Business Practice Location Address:
6701 E MILL PLAIN BLVD
Provider Second Line Business Practice Location Address:
NO SUITE
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98661-7459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-992-5726
Provider Business Practice Location Address Fax Number:
360-992-5728
Provider Enumeration Date:
10/30/2010