Provider First Line Business Practice Location Address:
1100 K AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANDE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97850-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-963-4184
Provider Business Practice Location Address Fax Number:
541-963-5272
Provider Enumeration Date:
03/08/2007