Provider First Line Business Practice Location Address:
340 SE HIGH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MITCHELL
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97750-0304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-462-3313
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2009