Provider First Line Business Practice Location Address:
1550 NW 11TH 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:
97838-6692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-564-2595
Provider Business Practice Location Address Fax Number:
541-564-3087
Provider Enumeration Date:
03/06/2007