Provider First Line Business Practice Location Address:
9020 SW WASHINGTON SQUARE RD
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-4491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-291-7155
Provider Business Practice Location Address Fax Number:
503-291-7152
Provider Enumeration Date:
07/07/2005