Provider First Line Business Practice Location Address:
2223 NE 47TH AVENUE
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:
97213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-335-2223
Provider Business Practice Location Address Fax Number:
503-282-1332
Provider Enumeration Date:
06/01/2007