Provider First Line Business Practice Location Address:
1100 SOUTHGATE STE 3
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:
97801-3971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-215-4440
Provider Business Practice Location Address Fax Number:
541-429-4118
Provider Enumeration Date:
02/17/2025