Provider First Line Business Practice Location Address:
1200 NW 23RD AVENUE
Provider Second Line Business Practice Location Address:
LEGACY CLINIC GOOD SAMARITAN
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-7074
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2016