Provider First Line Business Practice Location Address:
1100 SOUTHGATE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-3974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-1911
Provider Business Practice Location Address Fax Number:
541-278-1412
Provider Enumeration Date:
09/03/2013