Provider First Line Business Practice Location Address:
1201 SE 223RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-661-2828
Provider Business Practice Location Address Fax Number:
503-618-9874
Provider Enumeration Date:
09/20/2006