Provider First Line Business Practice Location Address:
1601 SE COURT AVE
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:
97801-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-966-0508
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2011