Provider First Line Business Practice Location Address:
1945 NE 205TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRVIEW
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97024-9622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-661-8050
Provider Business Practice Location Address Fax Number:
503-492-4651
Provider Enumeration Date:
04/15/2011