Provider First Line Business Practice Location Address:
3339 SE DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE F - AKASA THAI HEALING ARTS
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97202-1492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-230-8475
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2014