Provider First Line Business Practice Location Address:
24800 SE STARK ST FL 3
Provider Second Line Business Practice Location Address:
LEGACY MEDICINE INPATIENT SERVICE
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-674-1122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2007