Provider First Line Business Practice Location Address:
3150 BARNHART RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97338-9630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-831-3617
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2012