Provider First Line Business Practice Location Address:
25561 NW DAIRY CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLAINS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-647-0165
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2015