Provider First Line Business Practice Location Address:
11540 NE INVERNESS DR.
Provider Second Line Business Practice Location Address:
INVERNESS JAIL
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-988-5033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2019