Provider First Line Business Practice Location Address:
PO BOX 425
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLOWA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97885-0425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-886-2951
Provider Business Practice Location Address Fax Number:
541-886-7355
Provider Enumeration Date:
05/13/2025