Provider First Line Business Practice Location Address:
19267 N.W. PUMPKIN RIGDE 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:
97133-0050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-476-4303
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2008