Provider First Line Business Practice Location Address:
1397 MONMOUTH INDEPENDENCE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONMOUTH
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97361-1961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-838-1176
Provider Business Practice Location Address Fax Number:
503-837-3330
Provider Enumeration Date:
10/21/2021