Provider First Line Business Practice Location Address:
600 NW 11TH ST
Provider Second Line Business Practice Location Address:
SUITE E31
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-8605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-667-3657
Provider Business Practice Location Address Fax Number:
541-667-3659
Provider Enumeration Date:
08/30/2016