Provider First Line Business Practice Location Address:
34614 SPRAGUE RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRAGUE RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97639-8638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-539-1179
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2012