Provider First Line Business Practice Location Address:
5312 SE 52ND AVE
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:
97206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-775-7117
Provider Business Practice Location Address Fax Number:
503-775-7045
Provider Enumeration Date:
08/28/2006