Provider First Line Business Practice Location Address:
110 N COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEPPNER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97836-7328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-676-5421
Provider Business Practice Location Address Fax Number:
541-676-5652
Provider Enumeration Date:
08/03/2005