Provider First Line Business Practice Location Address: 
1920 NW LOVEJOY ST
    Provider Second Line Business Practice Location Address: 
JADE ACUPUNCTURE
    Provider Business Practice Location Address City Name: 
PORTLAND
    Provider Business Practice Location Address State Name: 
OR
    Provider Business Practice Location Address Postal Code: 
97209
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
503-417-1774
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/03/2011