Provider First Line Business Practice Location Address:
116 SE 187 ST
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:
97233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-666-1133
Provider Business Practice Location Address Fax Number:
503-665-2978
Provider Enumeration Date:
09/01/2006