Provider First Line Business Practice Location Address:
140 POPLAR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWERS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97466-0047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-439-7884
Provider Business Practice Location Address Fax Number:
541-439-3225
Provider Enumeration Date:
10/10/2006