Provider First Line Business Practice Location Address:
660 SW BRYANT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLATSKANIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-728-0587
Provider Business Practice Location Address Fax Number:
503-728-0608
Provider Enumeration Date:
04/13/2026