Provider First Line Business Practice Location Address:
5441 S MACADAM AVE STE A
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:
97239-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-440-1201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2026