Provider First Line Business Practice Location Address:
1601 E 4TH PLAIN BLVD
Provider Second Line Business Practice Location Address:
V3-HBPC
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:
360-905-1749
Provider Business Practice Location Address Fax Number:
360-690-0343
Provider Enumeration Date:
07/08/2006