Provider First Line Business Practice Location Address:
120 N. ATWATER ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONMOUTH
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-838-2998
Provider Business Practice Location Address Fax Number:
503-838-9993
Provider Enumeration Date:
09/08/2006