Provider First Line Business Practice Location Address:
26949 SUMMIT PRAIRIE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIE CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97869-8208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-313-8161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2025