Provider First Line Business Practice Location Address:
2215 13TH ST
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:
97814-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-213-3114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2017