Provider First Line Business Practice Location Address:
245 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE D4
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-561-6425
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2007