Provider First Line Business Practice Location Address:
5201 E FOURTH 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:
98661-7662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-248-8886
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2026