Provider First Line Business Practice Location Address:
2544 N. WATTS ST.
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:
97217-6368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-285-6676
Provider Business Practice Location Address Fax Number:
503-735-0523
Provider Enumeration Date:
05/08/2007