Provider First Line Business Practice Location Address:
2730 SW MOODY AVE CL5PA
Provider Second Line Business Practice Location Address:
OHSU PA PROGRAM
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-213-3872
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2016