Provider First Line Business Practice Location Address:
990 S HIGHWAY 395
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:
97838-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-564-1285
Provider Business Practice Location Address Fax Number:
541-564-1288
Provider Enumeration Date:
10/04/2019