Provider First Line Business Practice Location Address:
15480 S.E. 82ND DRIVE
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:
503-656-1680
Provider Business Practice Location Address Fax Number:
503-656-4940
Provider Enumeration Date:
01/21/2009