Provider First Line Business Practice Location Address:
10230 SW CAPITOL HWY
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:
97219-6809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-816-5551
Provider Business Practice Location Address Fax Number:
503-244-7683
Provider Enumeration Date:
04/07/2008