Provider First Line Business Practice Location Address:
2237 SW COURT 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:
97801-1896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-5053
Provider Business Practice Location Address Fax Number:
541-276-5112
Provider Enumeration Date:
06/15/2006