Provider First Line Business Practice Location Address:
11790 SW BARNES RD
Provider Second Line Business Practice Location Address:
STE. 140
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-5934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-643-2100
Provider Business Practice Location Address Fax Number:
503-643-7300
Provider Enumeration Date:
07/28/2010