Provider First Line Business Practice Location Address:
114 SE 1ST 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:
97801-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-429-9000
Provider Business Practice Location Address Fax Number:
855-738-7698
Provider Enumeration Date:
07/13/2011