Provider First Line Business Practice Location Address:
7201 N INTERSTATE AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-813-2000
Provider Business Practice Location Address Fax Number:
503-286-6879
Provider Enumeration Date:
07/12/2012