Provider First Line Business Practice Location Address:
320 S 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-2360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-567-8822
Provider Business Practice Location Address Fax Number:
541-564-6463
Provider Enumeration Date:
10/26/2006