Provider First Line Business Practice Location Address:
1955 NW NORTHRUP 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:
97209-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-227-2020
Provider Business Practice Location Address Fax Number:
503-222-0614
Provider Enumeration Date:
11/16/2005