Provider First Line Business Practice Location Address:
25050 SE STARK STREET
Provider Second Line Business Practice Location Address:
LEGACY MT HOOD MULTISPECIALTY CLINIC
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-5702
Provider Business Practice Location Address Fax Number:
503-413-6499
Provider Enumeration Date:
03/25/2009