Provider First Line Business Practice Location Address:
7219 SE YAMHILL ST
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:
97215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-415-1158
Provider Business Practice Location Address Fax Number:
503-334-0891
Provider Enumeration Date:
07/10/2007