Provider First Line Business Practice Location Address:
230 SE 2ND ST 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:
97838-2486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-289-7777
Provider Business Practice Location Address Fax Number:
541-289-7778
Provider Enumeration Date:
04/29/2013