Provider First Line Business Practice Location Address:
9221 SW BARBUR 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:
97219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-281-2266
Provider Business Practice Location Address Fax Number:
503-281-6844
Provider Enumeration Date:
02/15/2013