Provider First Line Business Practice Location Address:
1603 E 4TH PLAIN BLVD (V3VI)
Provider Second Line Business Practice Location Address:
VA MEDICAL CENTER
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:
360-696-4061
Provider Business Practice Location Address Fax Number:
360-905-1738
Provider Enumeration Date:
10/16/2006