Provider First Line Business Practice Location Address:
1120 CAMPBELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97814-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-523-2850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2019