Provider First Line Business Practice Location Address:
920 SW FRAZER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-304-5201
Provider Business Practice Location Address Fax Number:
360-844-5184
Provider Enumeration Date:
11/10/2010