Provider First Line Business Practice Location Address:
3165 10TH 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:
97814-1478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-519-7622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2015