Provider First Line Business Practice Location Address:
1575 NE 3RD ST
Provider Second Line Business Practice Location Address:
RITE AID #5393
Provider Business Practice Location Address City Name:
PRINEVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97754-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-447-2470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007