Individual
AMY CHRISTINE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3810 SE BELMONT ST, PORTLAND, OR 97214-4330
(503) 936-5340
Mailing address
3810 SE BELMONT ST, PORTLAND, OR 97214-4330
(503) 936-5340
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
6510
OR
Other
Enumeration date
07/11/2006
Last updated
07/08/2007
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