Provider First Line Business Practice Location Address:
348 W ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97720-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-573-8168
Provider Business Practice Location Address Fax Number:
541-573-8168
Provider Enumeration Date:
03/06/2026