Provider First Line Business Practice Location Address:
230 N 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97446-9679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-995-9711
Provider Business Practice Location Address Fax Number:
541-995-9226
Provider Enumeration Date:
01/12/2007