Provider First Line Business Practice Location Address:
3007 NE 53RD AVE
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:
97213-2439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-287-3330
Provider Business Practice Location Address Fax Number:
971-673-1100
Provider Enumeration Date:
02/19/2007