Provider First Line Business Practice Location Address:
400 MOTHER JOSEPH PLACE
Provider Second Line Business Practice Location Address:
SOUTHWEST WASHINGTON MEDICAL CENTER
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-806-0316
Provider Business Practice Location Address Fax Number:
360-835-0478
Provider Enumeration Date:
06/26/2006