Provider First Line Business Practice Location Address:
12776 SE 137TH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAPPY VALLEY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97086-5370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-908-5009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2026