Provider First Line Business Practice Location Address:
4224 NE HALSEY ST STE 300
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:
97213-1568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-235-5509
Provider Business Practice Location Address Fax Number:
503-235-5335
Provider Enumeration Date:
05/26/2009