Provider First Line Business Practice Location Address:
6409 E MILL PLAIN 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:
98661-7454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-693-2597
Provider Business Practice Location Address Fax Number:
360-695-0272
Provider Enumeration Date:
05/14/2007