Provider First Line Business Practice Location Address:
9609 E MILL PLAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-896-3022
Provider Business Practice Location Address Fax Number:
360-896-4185
Provider Enumeration Date:
01/08/2007