Provider First Line Business Practice Location Address:
331 SE 2D ST
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:
509-545-6506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2009