Provider First Line Business Practice Location Address:
527 SE BASELINE ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97123-4149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-648-8328
Provider Business Practice Location Address Fax Number:
503-648-8378
Provider Enumeration Date:
08/29/2006