Provider First Line Business Practice Location Address:
384 SE COMBS FLAT RD
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:
97754-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-447-8750
Provider Business Practice Location Address Fax Number:
541-447-8428
Provider Enumeration Date:
04/11/2011