Provider First Line Business Practice Location Address:
10117 SE SUNNYSIDE RD STE L
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-7708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-459-1099
Provider Business Practice Location Address Fax Number:
360-459-1974
Provider Enumeration Date:
08/01/2007