Provider First Line Business Practice Location Address:
670 COUNTY RD 83
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANBY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-947-7299
Provider Business Practice Location Address Fax Number:
541-947-3339
Provider Enumeration Date:
02/06/2007