Provider First Line Business Practice Location Address:
802 NE 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUFUR
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97021-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-289-5141
Provider Business Practice Location Address Fax Number:
541-705-3129
Provider Enumeration Date:
10/03/2025