Provider First Line Business Practice Location Address:
550 3RD ST
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:
97034-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-635-5044
Provider Business Practice Location Address Fax Number:
503-635-3255
Provider Enumeration Date:
09/23/2006