Provider First Line Business Practice Location Address:
2333 PACIFIC AVENUE
Provider Second Line Business Practice Location Address:
TUALITY HEALTHCARE FOREST GROVE SHOPPING CENTER
Provider Business Practice Location Address City Name:
FOREST GROVE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-359-6145
Provider Business Practice Location Address Fax Number:
503-359-6919
Provider Enumeration Date:
07/23/2006