Provider First Line Business Practice Location Address:
10249 NE CLACKAMAS 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:
97220-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-471-8070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2020