Provider First Line Business Practice Location Address:
12340 SE SUNNYSIDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-9320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-698-5525
Provider Business Practice Location Address Fax Number:
503-698-5524
Provider Enumeration Date:
06/30/2014