Provider First Line Business Practice Location Address:
8308 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:
98664-2066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-694-1118
Provider Business Practice Location Address Fax Number:
360-694-1979
Provider Enumeration Date:
11/26/2008