Provider First Line Business Practice Location Address:
708 K AVE STE 100
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:
97850-1392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-663-3202
Provider Business Practice Location Address Fax Number:
541-663-3211
Provider Enumeration Date:
07/03/2006