Provider First Line Business Practice Location Address:
1635 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97814-3856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-598-4598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2016