Provider First Line Business Practice Location Address:
5009 NE KILLINGSWORTH 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:
97218-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-402-8116
Provider Business Practice Location Address Fax Number:
503-284-2093
Provider Enumeration Date:
01/10/2007