Provider First Line Business Practice Location Address:
435 E NEWPORT AVE STE A
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:
97838-2487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-278-6330
Provider Business Practice Location Address Fax Number:
541-278-5419
Provider Enumeration Date:
09/28/2016