Provider First Line Business Practice Location Address:
117 THIRD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRAIN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-836-2371
Provider Business Practice Location Address Fax Number:
541-836-2374
Provider Enumeration Date:
10/16/2006