Provider First Line Business Practice Location Address:
2999 NE 181ST AVE
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:
97230-6923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-401-5201
Provider Business Practice Location Address Fax Number:
503-401-3322
Provider Enumeration Date:
05/01/2006