Provider First Line Business Practice Location Address:
221 SW TEXAS 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:
97219-2274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-245-9156
Provider Business Practice Location Address Fax Number:
503-246-8536
Provider Enumeration Date:
05/21/2007