Provider First Line Business Practice Location Address:
1601 EAST 4TH PLAIN BOULEVARD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER V3-SATP
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:
360-696-4061
Provider Business Practice Location Address Fax Number:
360-737-1419
Provider Enumeration Date:
07/25/2006