Provider First Line Business Practice Location Address:
PO BOX 1979
Provider Second Line Business Practice Location Address:
SUITE 101 TAI BETHANY PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
ESTACADA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97023-1979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-466-2254
Provider Business Practice Location Address Fax Number:
503-466-1143
Provider Enumeration Date:
05/15/2006