Provider First Line Business Practice Location Address:
10135 NW CURTIS ST
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:
97133-8235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-223-0958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2017