Provider First Line Business Practice Location Address:
16130 SE 82ND DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-657-6500
Provider Business Practice Location Address Fax Number:
503-557-0412
Provider Enumeration Date:
02/07/2007