Provider First Line Business Practice Location Address:
230 N 3RD ST STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97446-9679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-998-5660
Provider Business Practice Location Address Fax Number:
541-998-5678
Provider Enumeration Date:
04/23/2020