Provider First Line Business Practice Location Address:
545 NE 47TH AVE
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-230-0390
Provider Business Practice Location Address Fax Number:
503-230-0682
Provider Enumeration Date:
07/26/2006