Provider First Line Business Practice Location Address:
17 SW FRAZER AVE
Provider Second Line Business Practice Location Address:
SUITE 282
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-2163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-7824
Provider Business Practice Location Address Fax Number:
541-278-0353
Provider Enumeration Date:
02/18/2016