Provider First Line Business Practice Location Address:
1708 SW FRAZER AVE
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:
97801-2657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-969-7160
Provider Business Practice Location Address Fax Number:
541-315-1334
Provider Enumeration Date:
08/18/2010