Provider First Line Business Practice Location Address:
1122 W ELM 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:
97838-6933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-289-7075
Provider Business Practice Location Address Fax Number:
541-314-4873
Provider Enumeration Date:
04/27/2014