Provider First Line Business Practice Location Address:
202 W. LISTER ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAVE JUNCTION
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97523-0918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-592-6220
Provider Business Practice Location Address Fax Number:
541-592-6375
Provider Enumeration Date:
07/02/2007