Provider First Line Business Practice Location Address:
6651 SW CAPITOL HWY
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:
97219-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-451-3750
Provider Business Practice Location Address Fax Number:
503-245-4233
Provider Enumeration Date:
12/28/2005