Provider First Line Business Practice Location Address:
217 N. MAIN STR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEPPNER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97836-0427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-676-9158
Provider Business Practice Location Address Fax Number:
541-676-5015
Provider Enumeration Date:
03/06/2007