Provider First Line Business Practice Location Address:
4905 NE M L KING 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:
97211-3353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-288-7020
Provider Business Practice Location Address Fax Number:
503-288-7028
Provider Enumeration Date:
02/29/2016