Individual
SUGAR RAY BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6011 N GREELEY AVE APT B, PORTLAND, OR 97217-5057
(503) 238-0769
Mailing address
6011 N GREELEY AVE APT B, PORTLAND, OR 97217-5057
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
09/19/2007
Last updated
09/19/2007
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