Provider First Line Business Practice Location Address:
700 SUNSET DR STE A
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:
97850-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-963-1919
Provider Business Practice Location Address Fax Number:
541-975-5240
Provider Enumeration Date:
02/19/2007