Provider First Line Business Practice Location Address:
9555 SW BARNES RD
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-6663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-297-7403
Provider Business Practice Location Address Fax Number:
503-384-9908
Provider Enumeration Date:
05/23/2005