Provider First Line Business Practice Location Address:
2827 NE M L KING 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:
97212-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-928-8775
Provider Business Practice Location Address Fax Number:
503-282-1559
Provider Enumeration Date:
06/07/2010