Provider First Line Business Practice Location Address:
316 SE 80TH 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:
97215-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-254-7385
Provider Business Practice Location Address Fax Number:
503-257-3135
Provider Enumeration Date:
12/28/2006