Provider First Line Business Practice Location Address:
3181 S.W. SAM JACKSON PARK RD.
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:
97239-3098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-8311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2013