Provider First Line Business Practice Location Address:
16525 OAKDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97338-9644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-623-3881
Provider Business Practice Location Address Fax Number:
503-623-2751
Provider Enumeration Date:
11/13/2008