Provider First Line Business Practice Location Address:
290 WILLAMETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UMATILLA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97882-6601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-889-9167
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2016