Provider First Line Business Practice Location Address:
ACADEMY BUILDING
Provider Second Line Business Practice Location Address:
182 S.W. ACADEMY ST. SUITE 304
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-623-9289
Provider Business Practice Location Address Fax Number:
503-831-1726
Provider Enumeration Date:
05/24/2007