Provider First Line Business Practice Location Address:
7850 SW BARBUR BLVD
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:
97219-3089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-245-6484
Provider Business Practice Location Address Fax Number:
503-245-7872
Provider Enumeration Date:
09/20/2006