Provider First Line Business Practice Location Address:
443 NE KNOTT STREET
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:
97212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-282-5350
Provider Business Practice Location Address Fax Number:
503-282-1990
Provider Enumeration Date:
07/19/2006