Provider First Line Business Practice Location Address:
5417 NE 138TH AVE
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:
97230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-261-7541
Provider Business Practice Location Address Fax Number:
503-261-2048
Provider Enumeration Date:
11/28/2007