Provider First Line Business Practice Location Address:
777 SNAKE RIVER CORRECTIONAL INSTITUTION
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-245-1778
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2024