Provider First Line Business Practice Location Address:
3950 17TH ST STE A
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:
97814-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-523-1001
Provider Business Practice Location Address Fax Number:
541-523-1152
Provider Enumeration Date:
07/06/2022