Provider First Line Business Practice Location Address:
15312 SE KNAPP DR
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:
97236-7867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-740-2828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2026