Provider First Line Business Practice Location Address:
2111 NE HALSEY ST
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:
97232-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-284-2893
Provider Business Practice Location Address Fax Number:
503-287-2016
Provider Enumeration Date:
02/13/2007