Provider First Line Business Practice Location Address:
11126 NE HALSEY 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:
97220-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-256-5200
Provider Business Practice Location Address Fax Number:
503-253-7958
Provider Enumeration Date:
02/27/2009