Provider First Line Business Practice Location Address:
PO BOX 503
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUMSVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97325-0503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-231-5731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2026