Provider First Line Business Practice Location Address:
3181 SW SAM JACKSON PARK ROAD, MAILCODE: L466
Provider Second Line Business Practice Location Address:
OREGON HEALTH AND SCIENCE UNIVERSITY
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
80045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-2685
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2010