Provider First Line Business Practice Location Address:
200 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UMATILLA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97882-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-340-9793
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2023