Provider First Line Business Practice Location Address:
508 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANDE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97850-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-663-1200
Provider Business Practice Location Address Fax Number:
503-485-1279
Provider Enumeration Date:
03/25/2007