Provider First Line Business Practice Location Address:
700 SUNSET DR STE G
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:
97850-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-963-6070
Provider Business Practice Location Address Fax Number:
541-963-6490
Provider Enumeration Date:
11/21/2007