Provider First Line Business Practice Location Address:
4212 NE BROADWAY
Provider Second Line Business Practice Location Address:
MEDICAL STAFF SVCS
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-382-7709
Provider Business Practice Location Address Fax Number:
503-382-7706
Provider Enumeration Date:
06/21/2009