Provider First Line Business Practice Location Address:
1827 NE 44TH AVE
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-249-1350
Provider Business Practice Location Address Fax Number:
503-284-0792
Provider Enumeration Date:
10/31/2006