Provider First Line Business Practice Location Address:
8283 SW BARBUR BLVD
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:
97219-2871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-244-7331
Provider Business Practice Location Address Fax Number:
503-662-6344
Provider Enumeration Date:
11/26/2007