Provider First Line Business Practice Location Address:
3975 MIDWAY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97814-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-524-9070
Provider Business Practice Location Address Fax Number:
541-524-9077
Provider Enumeration Date:
08/02/2016