Provider First Line Business Practice Location Address:
528 E MAIN
Provider Second Line Business Practice Location Address:
SUITE W
Provider Business Practice Location Address City Name:
JOHN DAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-575-1466
Provider Business Practice Location Address Fax Number:
541-575-1411
Provider Enumeration Date:
08/22/2007