Provider First Line Business Practice Location Address:
710 SUNSET DR STE E
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:
97850-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-963-9843
Provider Business Practice Location Address Fax Number:
541-963-8746
Provider Enumeration Date:
03/14/2007