Provider First Line Business Practice Location Address:
1601 E. FOURTH PLAIN BLVD.
Provider Second Line Business Practice Location Address:
BUILDING #17
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-397-8246
Provider Business Practice Location Address Fax Number:
360-397-8450
Provider Enumeration Date:
12/13/2013