Provider First Line Business Practice Location Address:
7931 NE HALSEY ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213-6755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-255-1200
Provider Business Practice Location Address Fax Number:
503-408-6856
Provider Enumeration Date:
12/12/2008