Provider First Line Business Practice Location Address:
244 NW KINGWOOD AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756-1688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-316-2500
Provider Business Practice Location Address Fax Number:
541-316-2513
Provider Enumeration Date:
09/14/2005