Provider First Line Business Practice Location Address:
222 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97477-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-726-1961
Provider Business Practice Location Address Fax Number:
541-726-3926
Provider Enumeration Date:
09/25/2008