Provider First Line Business Practice Location Address:
2508 E L AVE
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:
97850-3495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-910-6322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006