Provider First Line Business Practice Location Address:
4950 NW 140TH AVE
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:
97229-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-481-2142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2014