Provider First Line Business Practice Location Address:
207 EAST 1ST ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLOWA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-886-2361
Provider Business Practice Location Address Fax Number:
541-886-6801
Provider Enumeration Date:
12/18/2006