Provider First Line Business Practice Location Address:
01315 SW SAM JACKSON PARK ROAD
Provider Second Line Business Practice Location Address:
MAIL CODE UHS-18
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-481-5257
Provider Business Practice Location Address Fax Number:
503-418-5317
Provider Enumeration Date:
03/06/2007