Provider First Line Business Practice Location Address:
808 SW CAMPUS DR
Provider Second Line Business Practice Location Address:
OREGON HEALTH & SCIENCE UNIVERSITY, KOHLER PAVILION
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-1164
Provider Business Practice Location Address Fax Number:
503-494-1159
Provider Enumeration Date:
04/04/2012