Provider First Line Business Practice Location Address:
316 N.E. 28TH 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:
97232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-230-0812
Provider Business Practice Location Address Fax Number:
503-233-9151
Provider Enumeration Date:
04/18/2007