Provider First Line Business Practice Location Address:
9499 SW WASHINGTON SQUARE RD
Provider Second Line Business Practice Location Address:
STE A1
Provider Business Practice Location Address City Name:
TIGARD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-968-5437
Provider Business Practice Location Address Fax Number:
503-968-5983
Provider Enumeration Date:
10/12/2006