Provider First Line Business Practice Location Address:
420 SMITH 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:
541-995-5266
Provider Business Practice Location Address Fax Number:
541-995-5245
Provider Enumeration Date:
06/16/2016