Provider First Line Business Practice Location Address:
SAM JACKSON PARK ROAD SW
Provider Second Line Business Practice Location Address:
DEPARTMENT OF INTERNAL MEDICINE, ENDOCRINOLOGY DIVISION
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-3273
Provider Business Practice Location Address Fax Number:
503-418-2208
Provider Enumeration Date:
06/24/2010