Provider First Line Business Practice Location Address:
1890 7TH 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:
97882-9826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-632-4050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2012