Provider First Line Business Practice Location Address:
622 AIRPORT RD
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:
97801-4598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-966-7776
Provider Business Practice Location Address Fax Number:
541-966-7799
Provider Enumeration Date:
09/28/2007