Provider First Line Business Practice Location Address:
110 SHANE BLDG.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-454-2888
Provider Business Practice Location Address Fax Number:
541-454-2988
Provider Enumeration Date:
05/15/2009