Provider First Line Business Practice Location Address:
1000 S HIGHWAY 395 STE A148
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:
97838-2695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-910-0364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2007