Provider First Line Business Practice Location Address:
31015 NW NORTH 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:
97133-6320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-266-1892
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2026