Provider First Line Business Practice Location Address:
5900 N LOMBARD ST
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:
97203-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-285-0229
Provider Business Practice Location Address Fax Number:
503-285-2508
Provider Enumeration Date:
12/13/2006