Provider First Line Business Practice Location Address:
646 SW UMATILLA AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756-7122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-330-3934
Provider Business Practice Location Address Fax Number:
541-504-2145
Provider Enumeration Date:
02/12/2010