Provider First Line Business Practice Location Address:
1805 3RD 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:
97814-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-739-5878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2022