Provider First Line Business Practice Location Address:
1601 SOUTHGATE PL
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:
97801-9432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-1987
Provider Business Practice Location Address Fax Number:
541-278-4788
Provider Enumeration Date:
02/27/2007