Provider First Line Business Practice Location Address:
1430 MONMOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-838-1133
Provider Business Practice Location Address Fax Number:
503-838-5138
Provider Enumeration Date:
09/06/2006