Provider First Line Business Practice Location Address:
: 51340 HIGHWAY 97, LA PINE, OR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PINE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97739-9871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-322-7500
Provider Business Practice Location Address Fax Number:
541-322-7565
Provider Enumeration Date:
08/06/2018