Provider First Line Business Practice Location Address:
400 NE MOTHER JOSEPH PL
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:
98664-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-514-1000
Provider Business Practice Location Address Fax Number:
360-604-1767
Provider Enumeration Date:
06/07/2011