Provider First Line Business Practice Location Address:
9450 SW BARNES RD STE 100
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:
97225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-292-9560
Provider Business Practice Location Address Fax Number:
503-292-9510
Provider Enumeration Date:
03/21/2007