Provider First Line Business Practice Location Address:
2800 WEMBLEY PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE OSWEGO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97034-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-745-6568
Provider Business Practice Location Address Fax Number:
503-734-6568
Provider Enumeration Date:
12/16/2025