Provider First Line Business Practice Location Address:
775 SW 9TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-683-2020
Provider Business Practice Location Address Fax Number:
541-683-1509
Provider Enumeration Date:
07/07/2008