Provider First Line Business Practice Location Address:
15875 SE 114TH AVE STE C
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-839-2000
Provider Business Practice Location Address Fax Number:
503-305-8027
Provider Enumeration Date:
12/12/2006