Provider First Line Business Practice Location Address:
207 E. 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLOWA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-605-3710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2009