Provider First Line Business Practice Location Address:
405 N. 1ST ST.
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-567-4063
Provider Business Practice Location Address Fax Number:
541-289-5064
Provider Enumeration Date:
12/09/2009