Provider First Line Business Practice Location Address:
5329 NE MLK JR BLVD
Provider Second Line Business Practice Location Address:
SECOND FLOOR/PHARMACY
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-988-3634
Provider Business Practice Location Address Fax Number:
503-988-3839
Provider Enumeration Date:
11/06/2018