Provider First Line Business Practice Location Address:
520 3RD ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97907-5054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-869-2204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006