Provider First Line Business Practice Location Address:
3586 NW 112TH PL
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:
97229-4585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-446-1210
Provider Business Practice Location Address Fax Number:
503-466-2791
Provider Enumeration Date:
09/02/2006