Provider First Line Business Practice Location Address:
955 W ORCHARD AVE
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:
97838-1591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-289-0955
Provider Business Practice Location Address Fax Number:
541-289-0956
Provider Enumeration Date:
12/30/2011