Provider First Line Business Practice Location Address:
400 NE MOTHER JOSEPH PL.
Provider Second Line Business Practice Location Address:
SW WASHINGTON MED CENTER,FBC-ANESTHESIA
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98668-9989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-514-4004
Provider Business Practice Location Address Fax Number:
360-514-4052
Provider Enumeration Date:
06/08/2005