Provider First Line Business Practice Location Address:
401 W MAIN ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHN DAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97845-1075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-575-1819
Provider Business Practice Location Address Fax Number:
541-575-0965
Provider Enumeration Date:
07/03/2009