Provider First Line Business Practice Location Address:
5717 NE 138TH AVE
Provider Second Line Business Practice Location Address:
AIRPORT WAY CENTER - MEDICATION MANAGEMENT PROGRAM
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97230-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-431-4404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2007