Provider First Line Business Practice Location Address:
218 N PINE STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-742-5023
Provider Business Practice Location Address Fax Number:
541-742-7210
Provider Enumeration Date:
04/02/2021