Provider First Line Business Practice Location Address:
2200 4TH 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:
97814-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-523-8211
Provider Business Practice Location Address Fax Number:
541-523-8242
Provider Enumeration Date:
08/31/2006