Provider First Line Business Practice Location Address:
1211 N WEBSTER 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:
97217-3747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-351-5426
Provider Business Practice Location Address Fax Number:
503-460-0176
Provider Enumeration Date:
07/06/2007