Provider First Line Business Practice Location Address:
8312 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:
98664-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-740-8640
Provider Business Practice Location Address Fax Number:
503-512-5384
Provider Enumeration Date:
12/08/2025