Provider First Line Business Practice Location Address:
133 E. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-852-7714
Provider Business Practice Location Address Fax Number:
503-852-7149
Provider Enumeration Date:
01/31/2011