Provider First Line Business Practice Location Address:
5329 NE MLK JR BLVD
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:
97211-3237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-988-5558
Provider Business Practice Location Address Fax Number:
503-988-5182
Provider Enumeration Date:
02/22/2007