Provider First Line Business Practice Location Address:
9136 ST. HELENS ST
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-1376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-657-9080
Provider Business Practice Location Address Fax Number:
503-675-9080
Provider Enumeration Date:
01/03/2007