Provider First Line Business Practice Location Address:
1605 N TOWNSEND RD
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:
97838-6769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
458-255-8461
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2026