Provider First Line Business Practice Location Address:
20 N.E. LILLICH ST.
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:
97016-0262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-728-4732
Provider Business Practice Location Address Fax Number:
503-728-3153
Provider Enumeration Date:
01/11/2007