Provider First Line Business Practice Location Address:
115 NW 6TH ST
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:
97801-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-300-9994
Provider Business Practice Location Address Fax Number:
541-276-8605
Provider Enumeration Date:
09/15/2008