Provider First Line Business Practice Location Address:
24800 SE STARK ST FL 3
Provider Second Line Business Practice Location Address:
LEGACY INPATIENT MEDICINE SERVICE
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97030-3378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-3882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2009