Provider First Line Business Practice Location Address:
201 N. 4TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALSEA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97324-0229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-487-7116
Provider Business Practice Location Address Fax Number:
541-487-4076
Provider Enumeration Date:
06/14/2006