Provider First Line Business Practice Location Address:
327 NW COUCH STREET
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:
97209-3920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-226-2765
Provider Business Practice Location Address Fax Number:
503-226-4243
Provider Enumeration Date:
01/02/2007