Provider First Line Business Practice Location Address:
365 N.E. COURT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINEVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-447-7441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2007