Provider First Line Business Practice Location Address:
6530 SW 30TH AVE
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:
97239-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-244-7533
Provider Business Practice Location Address Fax Number:
503-244-2396
Provider Enumeration Date:
09/01/2010