Provider First Line Business Practice Location Address:
591 NE 2ND ST
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:
97754-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-550-6200
Provider Business Practice Location Address Fax Number:
541-447-4118
Provider Enumeration Date:
12/09/2013