Provider First Line Business Practice Location Address:
1220 NW UPAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756-1253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-390-5964
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2026