Provider First Line Business Practice Location Address:
170 MELTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESWELL
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-895-2152
Provider Business Practice Location Address Fax Number:
541-895-2215
Provider Enumeration Date:
07/24/2012