Provider First Line Business Practice Location Address: 
500 ABERNETHY RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
OREGON CITY
    Provider Business Practice Location Address State Name: 
OR
    Provider Business Practice Location Address Postal Code: 
97045-1062
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
503-885-4778
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/12/2018