SHANE DALTON WIGHT

PORTLAND, OR
NPI1649829714
Other NameVIOLET RAINE ALICE WIGHT
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy372600000X Adult Companion
Enumeration Date2019-09-10
Last Update Date2019-09-10
Business Address
SHANE DALTON WIGHT QMHA
847 NE 19TH AVE
PORTLAND, OR 97232-2684
Phone number: 503-238-0769
Mailing Address
SHANE DALTON WIGHT QMHA
PO BOX 8459
PORTLAND, OR 97207-8459
Phone number: 503-238-0769
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