Provider First Line Business Practice Location Address:
8145 SW BARBUR BLVD
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:
97219-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-452-6212
Provider Business Practice Location Address Fax Number:
503-452-6816
Provider Enumeration Date:
10/30/2010