Provider First Line Business Practice Location Address:
19185 SW 90TH AVENUE
Provider Second Line Business Practice Location Address:
TUALATIN CLINIC
Provider Business Practice Location Address City Name:
TUALATIN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-885-7329
Provider Business Practice Location Address Fax Number:
503-885-7377
Provider Enumeration Date:
10/06/2008