Provider First Line Business Practice Location Address:
830 NE 47TH 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:
97213-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-215-2400
Provider Business Practice Location Address Fax Number:
503-215-0660
Provider Enumeration Date:
10/20/2006