Provider First Line Business Practice Location Address:
83365 JOSEPH HIGHWAY
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:
541-432-0100
Provider Business Practice Location Address Fax Number:
541-432-0100
Provider Enumeration Date:
04/07/2009