Provider First Line Business Practice Location Address:
1100 SOUTHGATE STE 2
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:
97801-3971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-215-1564
Provider Business Practice Location Address Fax Number:
541-215-1567
Provider Enumeration Date:
04/16/2013