Provider First Line Business Practice Location Address:
17733 NW PUMPKIN RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLAINS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97133-6155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-804-8048
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2009