Provider First Line Business Practice Location Address:
136 E PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL POINT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97502-2250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-665-2140
Provider Business Practice Location Address Fax Number:
541-665-2209
Provider Enumeration Date:
12/30/2010