Provider First Line Business Practice Location Address:
707 SW GAINES ST
Provider Second Line Business Practice Location Address:
CDRC
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-3877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2010