Provider First Line Business Practice Location Address:
11786 SW BARNES RD
Provider Second Line Business Practice Location Address:
STE 340
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-5930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-646-4600
Provider Business Practice Location Address Fax Number:
503-646-8180
Provider Enumeration Date:
06/14/2005