Provider First Line Business Practice Location Address:
16132 S THAYER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97045-9383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-707-4220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2022