Provider First Line Business Practice Location Address:
6700 NE PRESCOTT 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:
97218-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-916-6369
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2024