Provider First Line Business Practice Location Address:
7826 SW CAPITOL HWY
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:
97219-2466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-244-7788
Provider Business Practice Location Address Fax Number:
503-244-2809
Provider Enumeration Date:
01/23/2007