Provider First Line Business Practice Location Address:
PEACEHEALTH SW MEDICAL CENTER
Provider Second Line Business Practice Location Address:
400 NE MOTHER JOSEPH PL
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:
360-514-7654
Provider Business Practice Location Address Fax Number:
360-514-3146
Provider Enumeration Date:
03/07/2012