Provider First Line Business Practice Location Address:
107 SE SWAN AVENUE
Provider Second Line Business Practice Location Address:
CTSI DENTAL CLINIC
Provider Business Practice Location Address City Name:
SILETZ
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-444-9640
Provider Business Practice Location Address Fax Number:
541-444-9695
Provider Enumeration Date:
04/24/2007