Provider First Line Business Practice Location Address:
3181 SW SAM JACKSON PARK RD., GH219,
Provider Second Line Business Practice Location Address:
OHSU PA PROGRAM,
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:
208-720-0254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2015