Provider First Line Business Practice Location Address:
1015 NW 22ND AVE
Provider Second Line Business Practice Location Address:
LEGACY GOOD SAMARITAN HOSP. PATHOLOGY DEPT T-100
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97210-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-7319
Provider Business Practice Location Address Fax Number:
503-413-6411
Provider Enumeration Date:
02/01/2007