Provider First Line Business Practice Location Address:
920 SW FRAZER AVE STE 212
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:
97801-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-969-1941
Provider Business Practice Location Address Fax Number:
541-429-4941
Provider Enumeration Date:
03/14/2023