Provider First Line Business Practice Location Address:
14040 HIGHWAY 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT HOOD PARKDALE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97041-7816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-337-2292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2014