Provider First Line Business Practice Location Address:
3181 SW SAM JACKSON PARK ROAD
Provider Second Line Business Practice Location Address:
UHS 8EO
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-281-3432
Provider Business Practice Location Address Fax Number:
318-281-8850
Provider Enumeration Date:
01/30/2006