Provider First Line Business Practice Location Address:
2021 COURT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97814-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-239-5261
Provider Business Practice Location Address Fax Number:
541-239-5262
Provider Enumeration Date:
04/15/2020