Provider First Line Business Practice Location Address:
6400 N INTERSTATE 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:
97217-4834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-467-4848
Provider Business Practice Location Address Fax Number:
503-808-9911
Provider Enumeration Date:
09/29/2006