Provider First Line Business Practice Location Address:
10355 NW GLENCOE RD STE B
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:
97133-8244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-254-9988
Provider Business Practice Location Address Fax Number:
971-239-1906
Provider Enumeration Date:
04/22/2016