Provider First Line Business Practice Location Address:
431 SE 3RD ST
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:
97801-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-6774
Provider Business Practice Location Address Fax Number:
541-276-1486
Provider Enumeration Date:
06/05/2008