Provider First Line Business Practice Location Address:
7780 CLEAR CREEK RD
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:
97041-7800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-213-8412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2025