Provider First Line Business Practice Location Address:
7800 SW BARBUR BLVD BLDG 2
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:
97219-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-6780
Provider Business Practice Location Address Fax Number:
818-241-6853
Provider Enumeration Date:
12/19/2014