Provider First Line Business Practice Location Address:
1380 SW CANAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-797-6224
Provider Business Practice Location Address Fax Number:
541-797-6274
Provider Enumeration Date:
01/03/2026