Provider First Line Business Practice Location Address:
316 W. A 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:
541-836-7155
Provider Business Practice Location Address Fax Number:
541-836-7157
Provider Enumeration Date:
10/23/2007