Provider First Line Business Practice Location Address:
10424 SE CHERRY BLOSSOM DR STE I
Provider Second Line Business Practice Location Address:
CHERRY BLOSSOM WELLNESS & PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97216-2825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-419-8714
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2013