Provider First Line Business Practice Location Address:
270 NE 181ST AVENUE
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:
97230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-669-1966
Provider Business Practice Location Address Fax Number:
503-667-6599
Provider Enumeration Date:
09/27/2006