Provider First Line Business Practice Location Address:
1838 SW JEFFERSON 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:
97201-2463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-245-2929
Provider Business Practice Location Address Fax Number:
503-245-4478
Provider Enumeration Date:
04/22/2007