Provider First Line Business Practice Location Address:
550 NW 5TH ST
Provider Second Line Business Practice Location Address:
360 NW BEAVER ST
Provider Business Practice Location Address City Name:
PRINEVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97754-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-447-5521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2012