Provider First Line Business Practice Location Address:
6230 NE HALSEY 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:
97213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-279-2294
Provider Business Practice Location Address Fax Number:
971-339-2971
Provider Enumeration Date:
12/04/2007