Provider First Line Business Practice Location Address:
8325 SW 46TH 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:
97219-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-644-7005
Provider Business Practice Location Address Fax Number:
503-642-1025
Provider Enumeration Date:
02/24/2007