Provider First Line Business Practice Location Address:
116 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE1
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:
541-276-8224
Provider Enumeration Date:
11/14/2005