Provider First Line Business Practice Location Address:
1350 NE 122ND 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:
97230-2011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-408-7010
Provider Business Practice Location Address Fax Number:
503-408-7035
Provider Enumeration Date:
01/27/2006