Provider First Line Business Practice Location Address:
3001 ST ANTHONY WAY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-278-0535
Provider Business Practice Location Address Fax Number:
541-966-0574
Provider Enumeration Date:
06/28/2007