Provider First Line Business Practice Location Address:
717 1/2 E FIRST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBERG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-538-9867
Provider Business Practice Location Address Fax Number:
503-554-8388
Provider Enumeration Date:
08/31/2006