Provider First Line Business Practice Location Address:
182 S. W. ACADEMY ST.
Provider Second Line Business Practice Location Address:
ACADEMY BUILDING
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-623-2424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2013