Provider First Line Business Practice Location Address:
8501 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-4795
Provider Business Practice Location Address Fax Number:
360-718-2347
Provider Enumeration Date:
09/03/2008