Provider First Line Business Practice Location Address:
6767 NORTH BASIN AVE
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:
97217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-240-9343
Provider Business Practice Location Address Fax Number:
503-240-2568
Provider Enumeration Date:
12/04/2007