Provider First Line Business Practice Location Address:
104 SW KINKADE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOARDMAN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-481-2911
Provider Business Practice Location Address Fax Number:
541-481-2006
Provider Enumeration Date:
01/04/2017