Provider First Line Business Practice Location Address:
11820 SW KING JAMES PL #30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97224-2481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-625-4100
Provider Business Practice Location Address Fax Number:
971-245-6276
Provider Enumeration Date:
01/10/2007