Provider First Line Business Practice Location Address:
4424 NE GLISAN ST,
Provider Second Line Business Practice Location Address:
THE LI WELLNESS BUILDING, SECOND FLOOR
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-490-5580
Provider Business Practice Location Address Fax Number:
360-828-8147
Provider Enumeration Date:
03/08/2019