Provider First Line Business Practice Location Address:
116 S MAIN ST STE 1
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:
97801-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-4867
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2026