Provider First Line Business Practice Location Address:
10395 NW GLENCOE RD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
NORTH PLAINS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97133-8208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-647-9944
Provider Business Practice Location Address Fax Number:
503-647-0511
Provider Enumeration Date:
07/18/2007