Provider First Line Business Practice Location Address:
1590 NE 3RD ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINEVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97754-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-416-7476
Provider Business Practice Location Address Fax Number:
541-416-7478
Provider Enumeration Date:
11/10/2014