Provider First Line Business Practice Location Address:
2225 NE MLK BLVD
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:
97212-3788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-449-4465
Provider Business Practice Location Address Fax Number:
480-772-4995
Provider Enumeration Date:
03/29/2010