Provider First Line Business Practice Location Address:
1880 SW 6TH AVE
Provider Second Line Business Practice Location Address:
PORTLAND STATE UNIVERSITY -- SHAC
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97201-5204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-725-2800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2007