Provider First Line Business Practice Location Address:
240 EAST GLADYS AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-561-8050
Provider Business Practice Location Address Fax Number:
541-567-8454
Provider Enumeration Date:
10/12/2006