Provider First Line Business Practice Location Address:
865 LASALLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-995-6626
Provider Business Practice Location Address Fax Number:
541-995-3453
Provider Enumeration Date:
10/12/2006