Provider First Line Business Practice Location Address:
2121 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:
503-320-1342
Provider Business Practice Location Address Fax Number:
503-234-9639
Provider Enumeration Date:
06/12/2006