Provider First Line Business Practice Location Address:
1351 SW 41ST 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:
97801-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-240-1640
Provider Business Practice Location Address Fax Number:
541-966-6969
Provider Enumeration Date:
09/06/2007