Provider First Line Business Practice Location Address:
14279 S GLEN OAK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-657-7629
Provider Business Practice Location Address Fax Number:
503-557-8651
Provider Enumeration Date:
02/17/2026