Provider First Line Business Practice Location Address:
6350 NE HALSEY 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:
97213-4720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-215-2669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2006