Provider First Line Business Practice Location Address:
78798 ORDNANCE RD BLDG 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-9108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-564-5215
Provider Business Practice Location Address Fax Number:
541-564-5373
Provider Enumeration Date:
05/02/2008