Provider First Line Business Practice Location Address:
17700 SE MILL PLAIN
Provider Second Line Business Practice Location Address:
STE 150 TAI - VANCOUVER PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98683-5518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-514-9383
Provider Business Practice Location Address Fax Number:
360-514-0193
Provider Enumeration Date:
12/02/2005