Provider First Line Business Practice Location Address:
52515 COLUMBIA RIVER HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCAPPOOSE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-543-2444
Provider Business Practice Location Address Fax Number:
503-396-5936
Provider Enumeration Date:
04/19/2012