Provider First Line Business Practice Location Address:
1414 SE SALMON 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:
97214-3647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-989-1778
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2007