Provider First Line Business Practice Location Address:
8308 E MILL PLAIN BLVD STE 101
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:
360-256-6500
Provider Business Practice Location Address Fax Number:
360-256-2651
Provider Enumeration Date:
01/15/2026