Provider First Line Business Practice Location Address:
105 SOUTH 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST HELENS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97051-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-397-2990
Provider Business Practice Location Address Fax Number:
503-397-3198
Provider Enumeration Date:
02/22/2006