Provider First Line Business Practice Location Address:
9155 S.W. BARNES ROAD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-297-1421
Provider Business Practice Location Address Fax Number:
503-297-1421
Provider Enumeration Date:
11/02/2006