Provider First Line Business Practice Location Address:
23530 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-880-6877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2023