Provider First Line Business Practice Location Address:
3710 SW VETERANS HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
BLDG 104 PRIMARY CARE CLINIC
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97207-9823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-220-8262
Provider Business Practice Location Address Fax Number:
503-273-5210
Provider Enumeration Date:
10/25/2007