Provider First Line Business Practice Location Address:
401 B NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOSEPH
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-432-6555
Provider Business Practice Location Address Fax Number:
541-432-5051
Provider Enumeration Date:
07/26/2010