Provider First Line Business Practice Location Address:
9585 SW WASHINGTON SQUARE RD
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:
97223-4450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-320-2121
Provider Business Practice Location Address Fax Number:
503-641-4158
Provider Enumeration Date:
10/19/2010