Provider First Line Business Practice Location Address:
3181 SW SAM JACKSON PARK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-1303
Provider Business Practice Location Address Fax Number:
503-346-8021
Provider Enumeration Date:
06/09/2007