Provider First Line Business Practice Location Address:
10015 SE 49TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222-5121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-230-7231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2026