Provider First Line Business Practice Location Address:
5850 NE PRESCOTT ST
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:
97218-2232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-284-7268
Provider Business Practice Location Address Fax Number:
503-249-7202
Provider Enumeration Date:
05/08/2024