Provider First Line Business Practice Location Address:
16980 NW SOMERSET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97006-4760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-544-0144
Provider Business Practice Location Address Fax Number:
503-747-6610
Provider Enumeration Date:
04/23/2026