Provider First Line Business Practice Location Address:
331 SE 2ND ST
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:
97801-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-6207
Provider Business Practice Location Address Fax Number:
541-276-4628
Provider Enumeration Date:
10/05/2006