Provider First Line Business Practice Location Address:
1312 SW 2ND 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:
97801-4160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-215-1017
Provider Business Practice Location Address Fax Number:
541-215-1018
Provider Enumeration Date:
02/01/2019