Provider First Line Business Practice Location Address:
6400 SE LAKE RD
Provider Second Line Business Practice Location Address:
STE 285
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-786-4060
Provider Business Practice Location Address Fax Number:
503-652-6972
Provider Enumeration Date:
02/27/2007