Provider First Line Business Practice Location Address:
602 SE BYERS AVENUE
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:
97801-0040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-966-8551
Provider Business Practice Location Address Fax Number:
541-966-8554
Provider Enumeration Date:
10/11/2006