Provider First Line Business Practice Location Address:
700 CAMPBELL ST
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:
97814-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-523-0607
Provider Business Practice Location Address Fax Number:
541-523-0589
Provider Enumeration Date:
02/10/2012