Provider First Line Business Practice Location Address:
1705 MAIN ST STE 100
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:
97814-3459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-253-4550
Provider Business Practice Location Address Fax Number:
801-396-7066
Provider Enumeration Date:
08/26/2021