Provider First Line Business Practice Location Address:
301 NE KNOTT ST
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:
97212-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-253-3910
Provider Business Practice Location Address Fax Number:
503-253-4297
Provider Enumeration Date:
06/15/2006