Provider First Line Business Practice Location Address:
610 NW 11TH ST
Provider Second Line Business Practice Location Address:
C-111
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-6601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-946-4631
Provider Business Practice Location Address Fax Number:
509-943-6065
Provider Enumeration Date:
06/28/2010