Provider First Line Business Practice Location Address:
39971 GATES SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GATES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97346-9604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-509-8176
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2021