Provider First Line Business Practice Location Address:
611 NW BAILEY AVE
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:
97801-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-5080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2019