Provider First Line Business Practice Location Address:
3449 NE 25TH 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:
97212-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-493-7446
Provider Business Practice Location Address Fax Number:
503-493-7357
Provider Enumeration Date:
03/07/2008