Provider First Line Business Practice Location Address:
124 NW 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINEVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97754-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-480-4970
Provider Business Practice Location Address Fax Number:
425-876-2274
Provider Enumeration Date:
01/04/2007