Provider First Line Business Practice Location Address:
171 SW COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97338-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-831-1423
Provider Business Practice Location Address Fax Number:
503-831-1573
Provider Enumeration Date:
03/18/2009