Provider First Line Business Practice Location Address:
300 S.E.181ST. AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-667-2225
Provider Business Practice Location Address Fax Number:
503-666-2228
Provider Enumeration Date:
11/24/2006