Provider First Line Business Practice Location Address:
4805 NE ST JAMES RD
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:
98663-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-693-2544
Provider Business Practice Location Address Fax Number:
360-694-4233
Provider Enumeration Date:
03/20/2026