Provider First Line Business Practice Location Address:
3550 NORTH INTERSTATE AVE
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE EAST
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97227-1097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-331-5040
Provider Business Practice Location Address Fax Number:
503-331-5044
Provider Enumeration Date:
10/02/2006