Provider First Line Business Practice Location Address:
334 SW 7TH ST
Provider Second Line Business Practice Location Address:
STE A & B
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-265-4666
Provider Business Practice Location Address Fax Number:
541-265-6999
Provider Enumeration Date:
03/07/2008