Provider First Line Business Practice Location Address:
4310 NE KILLINGSWORTH 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:
97208-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-535-1150
Provider Business Practice Location Address Fax Number:
503-528-0800
Provider Enumeration Date:
05/12/2009