Provider First Line Business Practice Location Address:
11735 SE 129TH AVE
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:
97086-6239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-315-9150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2026