Provider First Line Business Practice Location Address:
2740 SE POWELL BLVD.
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:
97202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-688-2610
Provider Business Practice Location Address Fax Number:
503-231-4327
Provider Enumeration Date:
04/11/2016