Provider First Line Business Practice Location Address:
331 SE 2ND 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:
97801-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-889-9167
Provider Business Practice Location Address Fax Number:
541-889-7873
Provider Enumeration Date:
07/08/2008