Provider First Line Business Practice Location Address:
161 CANYON RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHOUGAL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98671-7571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-559-0063
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2026