Provider First Line Business Practice Location Address:
920 SW FRAZER
Provider Second Line Business Practice Location Address:
SUITE #214
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-1022
Provider Business Practice Location Address Fax Number:
541-966-9130
Provider Enumeration Date:
12/14/2005