Provider First Line Business Practice Location Address:
3455 SW VETERANS HOSPITAL RD
Provider Second Line Business Practice Location Address:
OHSU MAIL CODE SN-4S
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-2941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-3573
Provider Business Practice Location Address Fax Number:
503-494-4678
Provider Enumeration Date:
04/29/2008