Provider First Line Business Practice Location Address:
600 NW 11TH ST
Provider Second Line Business Practice Location Address:
SUITE E-37
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-8602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-667-3492
Provider Business Practice Location Address Fax Number:
541-667-3731
Provider Enumeration Date:
12/09/2005