Provider First Line Business Practice Location Address:
3727 NE MLK JR BLVD
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:
97212-1112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-788-7273
Provider Business Practice Location Address Fax Number:
503-788-7286
Provider Enumeration Date:
08/21/2017