Provider First Line Business Practice Location Address:
2119 NE HALSEY 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:
97232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-236-2000
Provider Business Practice Location Address Fax Number:
503-331-1069
Provider Enumeration Date:
06/20/2006