Provider First Line Business Practice Location Address:
7306 NE FREMONT 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:
97213-5840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-281-6616
Provider Business Practice Location Address Fax Number:
503-281-6333
Provider Enumeration Date:
02/21/2007