Provider First Line Business Practice Location Address:
182 S.W. ACADEMY ST.
Provider Second Line Business Practice Location Address:
304 ACADEMY BUILDING
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97338-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-831-5971
Provider Business Practice Location Address Fax Number:
503-831-1726
Provider Enumeration Date:
09/29/2009