Provider First Line Business Practice Location Address:
1055 S HIGHWAY 395 STE 323
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:
97838-6919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-564-4473
Provider Business Practice Location Address Fax Number:
541-564-8477
Provider Enumeration Date:
10/24/2006