Provider First Line Business Practice Location Address:
8614 E MILL PLAIN BLVD
Provider Second Line Business Practice Location Address:
STE #100
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-7725
Provider Business Practice Location Address Fax Number:
360-254-7727
Provider Enumeration Date:
05/08/2006