Provider First Line Business Practice Location Address:
3243 NE 52ND 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:
97213-2431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-864-4115
Provider Business Practice Location Address Fax Number:
530-534-3820
Provider Enumeration Date:
01/09/2008