Provider First Line Business Practice Location Address:
1050 W ELM AVE STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-667-3661
Provider Business Practice Location Address Fax Number:
541-275-8796
Provider Enumeration Date:
07/30/2026