Provider First Line Business Practice Location Address:
12000 SE 82ND AVENUE
Provider Second Line Business Practice Location Address:
#2012
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97266-7721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-652-6001
Provider Business Practice Location Address Fax Number:
503-652-6012
Provider Enumeration Date:
12/19/2006