Provider First Line Business Practice Location Address:
11145 NW MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLAINS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97133-7136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-764-7070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2022