Provider First Line Business Practice Location Address:
1343 A MONMOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97351-0248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-838-3001
Provider Business Practice Location Address Fax Number:
503-838-0994
Provider Enumeration Date:
02/23/2007