Provider First Line Business Practice Location Address:
215 E MAIN ST
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-1876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-667-7276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2008