Provider First Line Business Practice Location Address:
4400 NE HALSEY ST FL 4
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:
97213-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-893-6916
Provider Business Practice Location Address Fax Number:
503-893-6913
Provider Enumeration Date:
05/22/2007