Provider First Line Business Practice Location Address:
12000 SE 82ND AVE STE 2193
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAPPY VALLEY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97086-7746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-659-5947
Provider Business Practice Location Address Fax Number:
503-654-9330
Provider Enumeration Date:
10/11/2006