Provider First Line Business Practice Location Address:
802 WASHINGTON AVE
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:
97850-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-963-7643
Provider Business Practice Location Address Fax Number:
541-962-0497
Provider Enumeration Date:
06/09/2008