Provider First Line Business Practice Location Address:
1720 NW LOVEJOY ST
Provider Second Line Business Practice Location Address:
SOLACE THERAPEUTICS #107
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97209-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-957-9996
Provider Business Practice Location Address Fax Number:
888-311-5554
Provider Enumeration Date:
03/19/2009