Provider First Line Business Practice Location Address:
3231 SE 50TH 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:
97206-2248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-238-5203
Provider Business Practice Location Address Fax Number:
503-238-5202
Provider Enumeration Date:
07/04/2006