Provider First Line Business Practice Location Address:
945 S HIGHWAY 395 STE 2
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:
97838-2622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-269-7115
Provider Business Practice Location Address Fax Number:
541-636-7210
Provider Enumeration Date:
04/22/2025