Provider First Line Business Practice Location Address:
3030 AVENUE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97503-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-826-6800
Provider Business Practice Location Address Fax Number:
541-826-7008
Provider Enumeration Date:
12/21/2006