Provider First Line Business Practice Location Address:
700B NW 11 STREET
Provider Second Line Business Practice Location Address:
OREGON SCOTTISH RITE CLINIC
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-389-8201
Provider Business Practice Location Address Fax Number:
541-389-8201
Provider Enumeration Date:
04/25/2007