Provider First Line Business Practice Location Address:
19860 SE HIGHWAY 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAMASCUS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97089-5743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-908-5607
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2026