Provider First Line Business Practice Location Address:
39643 NW MURTAUGH 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:
97133-6143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-647-5189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2017