Provider First Line Business Practice Location Address:
3800 SE 22ND AVE
Provider Second Line Business Practice Location Address:
MAILSTOP 04002/34K
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97202-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-797-7144
Provider Business Practice Location Address Fax Number:
187-737-6948
Provider Enumeration Date:
12/20/2012