Provider First Line Business Practice Location Address:
4849 NE 138TH AVE
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:
97230-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-257-3935
Provider Business Practice Location Address Fax Number:
503-253-3747
Provider Enumeration Date:
09/27/2011