Provider First Line Business Practice Location Address:
635 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHN DAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97845-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-313-5492
Provider Business Practice Location Address Fax Number:
541-393-9087
Provider Enumeration Date:
11/17/2025