Provider First Line Business Practice Location Address:
1606 NE 223RD 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:
97024-2662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-665-3608
Provider Business Practice Location Address Fax Number:
503-665-0809
Provider Enumeration Date:
03/30/2007