Provider First Line Business Practice Location Address:
198 NE COMBS FLAT RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINEVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97754-2563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-447-4111
Provider Business Practice Location Address Fax Number:
541-416-9570
Provider Enumeration Date:
09/16/2009