Provider First Line Business Practice Location Address:
8040 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:
98664-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-882-2778
Provider Business Practice Location Address Fax Number:
360-604-1757
Provider Enumeration Date:
10/27/2020