Provider First Line Business Practice Location Address:
130 N CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
JOHN DAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97845-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-953-5507
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2014