Provider First Line Business Practice Location Address:
530 1ST ST
Provider Second Line Business Practice Location Address:
SUITE B-1
Provider Business Practice Location Address City Name:
LAKE OSWEGO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97034-3248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-804-0133
Provider Business Practice Location Address Fax Number:
503-594-1114
Provider Enumeration Date:
11/06/2009