Provider First Line Business Practice Location Address:
8506 E MILL PLAIN BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-2011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-896-2222
Provider Business Practice Location Address Fax Number:
360-896-8881
Provider Enumeration Date:
10/31/2006