Provider First Line Business Practice Location Address:
VA MEDICAL CENTER
Provider Second Line Business Practice Location Address:
3710 S.W. US VETERANS HOSPITAL ROAD (V-3-CNH)
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97209-2964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-650-7078
Provider Business Practice Location Address Fax Number:
503-650-4726
Provider Enumeration Date:
09/13/2006