Provider First Line Business Practice Location Address:
17 SW FRAZER AVE STE 282
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:
97801-0048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-278-6330
Provider Business Practice Location Address Fax Number:
541-278-5419
Provider Enumeration Date:
02/26/2016