Provider First Line Business Practice Location Address:
UHS-8L
Provider Second Line Business Practice Location Address:
3181 S.W. SAM JACKSON PARK ROAD
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-4989
Provider Business Practice Location Address Fax Number:
503-418-0084
Provider Enumeration Date:
02/07/2020