Provider First Line Business Practice Location Address:
8401 NE HALSEY ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97220-5670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-977-0400
Provider Business Practice Location Address Fax Number:
208-248-0977
Provider Enumeration Date:
05/05/2007