Provider First Line Business Practice Location Address:
21001 NW DAIRY CREEK RD
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:
97133-6115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-964-3729
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2025