Provider First Line Business Practice Location Address:
427 N. MAIN ST.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PRINEVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-447-1593
Provider Business Practice Location Address Fax Number:
541-447-5437
Provider Enumeration Date:
05/10/2007