Provider First Line Business Practice Location Address:
29277 NW 292ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLAINS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97133-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-496-3500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2026