Provider First Line Business Practice Location Address:
208 NW CANTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHN DAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97845-1145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-575-2725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2007