Provider First Line Business Practice Location Address:
400 NE MOTHER JOSEPH PL
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:
98664-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-2863
Provider Business Practice Location Address Fax Number:
503-284-9404
Provider Enumeration Date:
01/23/2008