Provider First Line Business Practice Location Address:
7215 SE MILWAUKIE AVE
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:
97202-6103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-233-5273
Provider Business Practice Location Address Fax Number:
503-236-2796
Provider Enumeration Date:
01/28/2011