Provider First Line Business Practice Location Address:
0615 SW PALATINE HILL RD MSC 17
Provider Second Line Business Practice Location Address:
LEWIS & CLARK COLLEGE
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-768-7032
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2006