Provider First Line Business Practice Location Address:
5071 NE 122ND 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:
97230-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-255-5700
Provider Business Practice Location Address Fax Number:
503-255-2099
Provider Enumeration Date:
10/10/2006