Provider First Line Business Practice Location Address:
12153 SE OATFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222-6950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-387-3348
Provider Business Practice Location Address Fax Number:
503-387-3347
Provider Enumeration Date:
05/16/2006