Provider First Line Business Practice Location Address:
3550 N INTERSTATE AVE
Provider Second Line Business Practice Location Address:
INTERSTATE MEDICAL OFFICE-EAST
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97227-1196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-331-6283
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2006