Provider First Line Business Practice Location Address:
215 SW 10TH 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:
97801-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-389-5570
Provider Business Practice Location Address Fax Number:
888-342-6115
Provider Enumeration Date:
12/03/2007