Provider First Line Business Practice Location Address:
955 W. ORCHARD AVE.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-334-5426
Provider Business Practice Location Address Fax Number:
541-289-9868
Provider Enumeration Date:
02/03/2009