Provider First Line Business Practice Location Address:
2100 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97814-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-523-7400
Provider Business Practice Location Address Fax Number:
541-523-4927
Provider Enumeration Date:
06/10/2013