Provider First Line Business Practice Location Address:
4300 NE FREMONT ST.
Provider Second Line Business Practice Location Address:
STE.230
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-477-7907
Provider Business Practice Location Address Fax Number:
503-477-7913
Provider Enumeration Date:
10/22/2014