Provider First Line Business Practice Location Address:
1312 SW WASHINGTON 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:
97205-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-535-1151
Provider Business Practice Location Address Fax Number:
503-535-1191
Provider Enumeration Date:
05/24/2011