Provider First Line Business Practice Location Address:
9427 S.W. BARNES ROAD
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:
97225-7225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-571-2727
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006