Provider First Line Business Practice Location Address:
655 N 8TH 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:
97446-9552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-512-9710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2023