Provider First Line Business Practice Location Address:
3181 SW JACKSON PARK BLVD
Provider Second Line Business Practice Location Address:
OREGON HEALTH & SCIENCE UNIVERSITY
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-418-0980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2006