Provider First Line Business Practice Location Address:
1744 NE 42ND AVE STE A
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:
97213-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-427-8427
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2009