Provider First Line Business Practice Location Address:
5819 N GREELEY AVE STE 101
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:
97217-4159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-278-3385
Provider Business Practice Location Address Fax Number:
503-278-3386
Provider Enumeration Date:
09/30/2008